Journal of Global Infectious Diseases

LETTER TO EDITOR
Year
: 2015  |  Volume : 7  |  Issue : 1  |  Page : 47--48

Low rates of Hepatitis B and Human Immunodeficiency Virus coinfection in rural northern Tanzania


Jose D Debes1, William M Stauffer1, Mark Jacobson2, David R Boulware1,  
1 Department of Medicine, University of Minnesota, Minneapolis, MN, USA
2 Arusha Lutheran Medical Centre, Arusha, Tanzania

Correspondence Address:
Jose D Debes
Department of Medicine, University of Minnesota, Minneapolis, MN
USA




How to cite this article:
Debes JD, Stauffer WM, Jacobson M, Boulware DR. Low rates of Hepatitis B and Human Immunodeficiency Virus coinfection in rural northern Tanzania.J Global Infect Dis 2015;7:47-48


How to cite this URL:
Debes JD, Stauffer WM, Jacobson M, Boulware DR. Low rates of Hepatitis B and Human Immunodeficiency Virus coinfection in rural northern Tanzania. J Global Infect Dis [serial online] 2015 [cited 2019 Jul 16 ];7:47-48
Available from: http://www.jgid.org/text.asp?2015/7/1/47/150893


Full Text

Sir,

Hepatitis B (HBV) is a leading cause of liver disease in resource-limited settings. [1] Hepatitis B shares infection routes with the human immunodeficiency virus (HIV). Therefore, areas with high HIV endemicity, such as sub-Saharan Africa, are expected to have high rates of HBV coinfection. [2] In the setting of HIV coinfection, both morbidity and mortality from HBV are increased, compared to non coinfected populations. [2] However, although the rates of HIV and HBV are well-established in high-income countries, there is a paucity of knowledge in many resource-limited settings. We conducted a prospective cohort study to determine the incidence of HBV coinfection in HIV-infected persons in Arusha, Tanzania. Informed consent was obtained from 156 consecutive HIV-infected, antiretroviral-naοve persons, who were initiating HIV therapy at the Selian Lutheran Hospital (n = 21) or Arusha Town Clinic (n = 135). The participants were enrolled for two, three-month time periods. The participants were tested for hepatitis B surface antigen (HBsAg) and Alanine aminotransferase (ALT). HBsAg was analyzed initially by the one-step rapid test (Abon Biopharm, Hangzhou, China) at the Selian Hospital Laboratory. For quality assurance, 15 samples, from the Arusha Town Clinic, were tested by a second rapid assay (Eurostrip, Euromedic Equipment, Netherlands) at a different laboratory.

Demographics showed an average age of 33 + 11 years, with 62% (88/141) being women. The average CD4 count was 105 + 91 cells/mL. The average ALT levels were 30 + 19 U/L among 82 specimens tested. Surprisingly, only 3.2% (5/156) of the HIV-infected participants were positive for HBsAg (95% CI, 1.0 to 7.3%).

The total seroprevalence of HBV coinfection among the HIV-infected persons, of 3.2%, was lower than expected and much lower than other reports, either from Tanzania, other parts of Africa or high-income countries. [2] In Dar es Salaam and Tanzania, Matee et al. reported 8.5% seroprevalence of HBsAg in the HIV-infected and 8.7% in the HIV-negative samples screened for blood donation. [3] In Ifakara, Tanzania, Fabian et al. reported 9.2% seroprevalence of HBV in HIV-infected patients. [4] Our population group differed from other locations in Tanzania, due to a large number of Massai inhabitants. The Massai are a nomadic tribe residing in the area, and the low HBsAg seroprevalence could be due to differences in customary habits, historical isolation, and/or lack of access to healthcare. Interestingly, a recent study by Honge et al. described how rapid tests might underestimate HBV prevalence in HIV-infected patients. [5] In our study we used two different brands to detect the HBV antigen, but both were rapid tests. On account of lack of resources in the area, we could not test for the prevalence of the hepatitis B core antibody, to assess the overall level of exposure of hepatitis B. In our study we did not address the vaccination history; however, HBV vaccination among adults is rare in rural Tanzania. We believe that this surprisingly low coinfection rate needs further research.

 ACKNOWLEDGMENTS



Partially funded by NIH T32 AI055433 to JD

References

1Osborn MK, Guest JL, Rimland D. Hepatitis B virus and HIV coinfection: Relationship of different serological patterns to survival and liver disease. HIV Med 2007;8:271-9.
2Barth RE, Huijgen Q, Taljaard J, Hoepelman, AI. Hepatitis B/C and HIV in sub-Saharan Africa: An association between highly prevalent infectious diseases. A systematic review and meta-analysis. Int J Infect Dis 2010;14:e1024-31.
3Matee MI, Magesa PM, Lyamuya EF. Seroprevalence of human immunodeficiency virus, hepatitis B and C viruses and syphilis infections among blood donors at the Muhimbili National Hospital in Dar es Salaam, Tanzania. BMC Public Health 2006;30:6-21.
4Franzeck FC, Ngwale R, Msongole B, Hamisi M, Abdul O, Henning L, et al. Viral hepatitis and rapid diagnostic test based screening for HBsAg in HIV-infected patients in rural Tanzania. PLoS One 2013;8:e58468.
5Hønge B, Jespersen S, Medina C, Té D, da Silva Z, Ostergaard L, et al. Hepatitis B virus surface antigen and anti-hepatitis C virus rapid tests underestimate hepatitis prevalence among HIV-infected patients. HIV Med 2014;15:571-6.