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Hepatitis B and Hepatitis C Viruses infections among ARV- naive and experienced HIV co-infected adults in Addis Ababa, E

Hepatitis B and Hepatitis C Viruses infections among ARV- naive and experienced HIV co-infected adults in Addis Ababa, Ethiopia. Tsegahun Manyzewal 1 , Zufan Sisay 1 , Sibhatu Biadgilign 2, Woldaregay Erku 1

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Hepatitis B and Hepatitis C Viruses infections among ARV- naive and experienced HIV co-infected adults in Addis Ababa, E

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  1. Hepatitis B and Hepatitis C Viruses infections among ARV- naive and experienced HIV co-infected adults in Addis Ababa, Ethiopia Tsegahun Manyzewal1, Zufan Sisay1, Sibhatu Biadgilign2, Woldaregay Erku 1 1Aklilu Lemma Institute of Pathobiology, College of Health Sciences, Addis Ababa University 2Department of Epidemiology and Biostatistics, College of Public Health and Medical Science, Jimma University

  2. Presentation outline • Introduction • Objective • Methods • Results • Discussion • Conclusions • Recommendation • Reference • Acknowledgment

  3. Introduction • The estimated number of people living with Human Immunodeficiency Virus (HIV) worldwide in 2009 was 33.2 million and that of adult People Living With HIV/AIDS (PLWHA) was 30.7 million. • As many as 12% of them were co-infected with Hepatitis B Virus (HBV). • Similarly, worldwide, Hepatitis C Virus (HCV) accounts for approximately 130 million chronic infections, with an overall 3% prevalence. • Four to 5 million of them were co-infected with HIV .

  4. Conti… • Studies carried out in Ethiopia on HIV positive persons show prevalence of Hepatitis B surface antigen (HBsAg) and anti-HCV to be 3.9% and 4.5% respectively. • HIV-HCV or HIV-HBV co-infection is becoming a leading cause of death among HIV infected persons worldwide . • There is a significantly elevated relative ratio of severe liver disease, hepatocellular carcinoma

  5. Conti… • These co-infections are of great interest due to their association with failure of ARV. • In patients with HIV-HBV co-infections, greater immunocompromise was associated with continued HBV viraemia while on Lamivudine • Because of the seriousness of HBV and HCV co-infections with HIV, it is important to know on existing trend of the diseases and consider new opportunities that could prevent disease transmission and further complications.

  6. Objective • This study aimed at investigating existing trend of HBV and HCV co-infections with HIV and explores the relation of HBV markers among ARV-naïve and experienced subjects co-infected with HIV

  7. Method and materials • This cross sectional study in Addis Ababa • Frozen serum and plasma samples-adults seeking VCT and ARV services in Bethezata Health service and Bethel Teaching General Hospital. • The study population comprised of all HIV positive ARV naïve and experienced clients during the sample collection period.

  8. Specimen and data collection • A sum of 500 HIV positive serum and plasma samples collected from both ARV naive (n=250) and ARV experienced (n=250) subjects were used to conduct this study. • The samples were collected from VCT attendants at Bethezatha Hospital and its VCT centers, and from ARV therapy attendants at Bethezata Hospital and Bethel Teaching General Hospital. • Demographic data including age, sex and address, and sample code numbers were collected from registration logbooks. • Assessment was made between code numbers labeled on test tubes and registration books for confirming the data.

  9. Serological Test • Keeping at 20C temperature condition in an icebox, the samples were transported quickly from their respective sources to the Microbiology and Immunology laboratory of Aklilu Lemma Institute of Pathobiology for serological tests. • Sera were tested for HBsAg, anti-HBs, HBeAg, and antibody to hepatitis C virus (anti-HCV) using a rapid immunochromatographic assay designed for testing HBV markers. • Sera tested positive for HBsAg marker were confirmed by third generation Enzyme Linked Immunosorbent Assay (ELISA)

  10. Measurement • The dependent variables were detection of HCV antibodies and HBV markers. • The independent variables were age, sex, and ARV status. • A retrospective quantitative data extracted from the registration book were checked for completeness and consistency by the principal investigator. • Data entry and analysis were carried out using SPSS version 13 Software for windows

  11. Conti… • Ethical clearance was obtained from Aklilu Lemma Institute of Pathobiology Ethical Review Committee, Addis Ababa University (ALIPB, AAU).

  12. ResultTable 1: Demographic characteristics of ARV-naïve and experienced study subjects

  13. Table 2: HBV markers and their relation among each other in serum and plasma samples collected from ARV naïve and experienced study subjects

  14. Table 3: HBV markers and their prevalence among the two sexes in sera collected from ARV naïve and experienced study subjects

  15. Table 4: HBV markers and their prevalence in serum and plasma samples collected from ARV naïve and experienced study subjects

  16. Table 5: HBV markers and their prevalence among the different age groups in serum and plasma samples collected from ARV naïve and experienced study subjects

  17. Discussion • In this study, the overall prevalence of HBsAg was 3%, which is lower than the 3.9% observed in Addis Ababa, Ethiopia, 14% observed in Shashemene General Hospital, Ethiopia , also lower compared to the global prevalence of 12% , 9.6% in the eastern province of Gabon , and 6.3% in Australia. • HBsAg, which is the first detectable viral antigen to appear during infection and most frequently used to screen for the presence of HBV infection, was used to approximate prevalence of HBV infection.

  18. Conti… • Presence of this antigen in the study subjects could show on the risk of liver damage to the patients. • However, the most decisive concern was that 7/250 (1.4%) of patients who were on HAART, including patients taking Lamivudine, for a minimum of 6 months was diagnosed positive for HBsAg. • In this study, simultaneous presence of HBsAg and anti-HBs in the study subject was clinically insignificant, and is lower when compared to result observed in similar studies.

  19. Conti… • Though the mechanism underlying the presence of both markers remains unknown, simultaneous existence of these markers in a patient suggests a selection of HBV immune escape mutants which could lead to drug resistance. • Similarly, only 3/500 (0.6%) patients were positive for both HBsAg and HBeAg, suggesting that a better survival free of hepatic complications was observed in almost all patients.

  20. Conti… • The HBeAg, which could potentially indicate that the virus is replicating and the infected individuals have higher level of HBV , is detected in a few patients when compared to anti-HBs that does not necessarily show the current HBV status of the study participants. • However, anti-HBs were not detected in 88.4% of the study subjects showing that a very few patients have protective levels of antibodies against HBsAg. • Likewise, prevalence of anti-HCV observed in this study, 3.6 %, was slightly lower than similar studies conducted previously in Ethiopia and elsewhere; 13.1% , 4.5 % . Observed differences may be due to difference in study population.

  21. Limitation of the study • missing of some information during data collection like the types of ARVs that patients were taking, duration of treatment, adherence, blood transfusion history • HBcAg and anti-HBc test was not included on the study that could have given further information on whether HBsAg and anti-HBs-negative samples were in the “window period’. • The use of HCV RNA detection via PCR amplification for anti-HCV negative samples could also prevent the possibility of missing HCV infection from subjects that were very recently infected.

  22. Strength of the study • The use of large sample size • Application of ELISA technique to confirming HBsAg detected by rapid test devises

  23. Conclusion • Many of the study participants were not immune to HCV and HBV infections. • HBV and HCV infection were not significantly different due to ART status which suggests that the two groups have equal chances to be infected with these two infections, despite disease progression.

  24. Recommendations • Current HIV/AIDS treatment algorithm should incorporate screening of all HIV infected persons for HBV and HCV markers, • immunizing patient screened negative for HBV markers and • providing health education about methods of HCV and HCV prevention for HIV co-infected patients. • A more inclusive study is recommended to elucidate the full extent of this problem at national level.

  25. References….selected • WHO: Antiretroviral therapy for HIV infection in adults and adolescents: Recommendations for a public health approach. World Health Organization 2010. Available at http://www.who.int/hiv/pub/guidelines/ • Aceti A, Pasquazzi C, Zechini B, De Bac C. Hepatotoxicity development during antiretroviral therapy containing protease inhibitors in patients with HIV: the role of hepatitis B and C virus infection. J Acquir Immune Defic Syndr. 2002;29(1):41-8. • Operskalski AE, Kovacs A. HIV/HCV Co-infection: Pathogenesis, Clinical Complications, Treatment, and New Therapeutic Technologies. Curr HIV/AIDS Rep 2011;8:12–22 • Shimelis T, Torben W, Medhin G, Tebeje M, Demessie F, et al. Hepatitis B Virus infection among attendants of Voluntary Counseling and Testing Center and Anti-retroviral Therapy Clinic of Saint Pauls General Specialized Hospital, Addis Ababa, Ethiopia. Sex Transm Infect. 2008 84:37-41. • Frommel D, Tekle-Haimanot R, Berhe N, Aussel L, Verdier M, Preux PM, Denis F. A survey of antibodies to hepatitis C virus in Ethiopia. Am J Trop Med Hyg 1993;49:435–39 • Koziel MJ, Peters MG. Viral Hepatitis in HIV Infection. N Engl J Med. 2007; 356:1445-54 • González-García J, Guerra L, Amela C, et al. Coinfection by HIV and hepatitis A, B and C virus in adult patients. Practice guidelines for management of HIV infection. Review and GESIDA/PNS recommendations (2000-2002). 2003. • Bonacini M, Louie S, Bzowej N, Wohl AR. Survival in patients with HIV infection and viral hepatitis B or C: a cohort study. AIDS 2004;18: 2039-45 • Federal Ministry of Health (FMoH), HIV/AIDS Prevention and Control Office (FHAPCO), and Drug Administration and Control Agency (DACA). Guideline in the use of Antiretrovirals in Ethiopia. FMoH, Addis Ababa, Ethiopia. 2003

  26. Acknowledgment • Aklilu Lemma Institute of Pathobiology, College of Health Sciences, Addis Ababa University for funding the study and allowing serological testes to be done in its Immunology and serology Laboratory. • We also would like to thank Bethezata Health services P.L.C and Bethel Teaching General Hospital for their cooperation.

  27. thank you

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