Asian Pac. J. Health Sci.

, 2014; 1(4): 507-511 e-ISSN: 2349-0659, p-ISSN: 2350-0964

____________________________________________________________________________________________________________________________________________

Prevalence of hepatitis- B virus infection among HIV patients in Ikole Ekiti, South –
Western, Nigeria

OO Opaleye1, AS Oluremi1*, DO Ogbolu2, BA Babalola3, T Shittu4, AA Adesiyan2

1
Department of Medical Microbiology and Parasitology, Lautech, Nigeria
2
Biomedical Science Department, Lautech, Nigeria
3
Specialist Hospital, Ikole Ekiti, Nigeria
4
Medical laboratory Science Department, Lautech Teaching Hospital, Ogbomoso, Nigeria

ABSTRACT

Infections from HIV, Hepatitis B virus constitute a major public health challenge in sub-Saharan Africa, and there
are evidences to suggest that there is faster progression of HIV in those co-infected with either HBV. The aim of this
study was to determine the prevalence of HBV infections among HIV-infected patients, and describe the socio-
demographic features and correlates of HIV and HBV co-infected patients at Specialists Hospital, Ekiti, Nigeria.
One hundred and fifty eight (158) HIV individuals who consented to the study were tested for HBV using Diaspot
HBsAg kit (Screening test) and Biorex Diagnostic ELISA kit (Confirmatory test) between November 2012 and
April, 2013. CD4 counts were also analysed with Aldrich Sigma kit and flow cytometery respectively. P value <
0.05 was considered to be significant. Prevalence rates of Hepatitis B infections among HIV obtained were 5.7%.
Individuals who were 51 years or younger were the most affected HBV co-infection was more common among
females than males (3.8%: 1.8%, res, P = 0.0004). Out of 9 patients, 8 patients (88.9%) fell within the age range 30-
49 years which implies the high prevalence of HIV among labour force while 1 patient (11.1%) fell within the range
of 50-60 years .Mean serum ALT and AST among participants with HIV alone were (42.0, 38.3) International Units
(IU), but were significantly higher (57.6, 43.7) International Units (IU) for those with HIV/HBV co-infection, P =
(0.048, 0.032).Mean CD 4 count for HIV/HBV co-infected participants (389 cell/mm 3 ) was significantly higher
than that for participants with HIV alone (230 cell/mm 3 ), P = 0.024 Conclusion: Co-infection with hepatitis B
virus is common among HIV-infected patients in our setting and this further reaffirms the need for routine baseline
screening for this marker, as it is a major consideration in the initiation and choice of highly active antiretroviral
therapy. Furthermore, those found to be negative should be immunized with HBV vaccine to improve the prognosis
of their HIV status.

Keywords: Hepatitis B, Hepatitis C, HIV, Nigeria, Prevalence.

Introduction

There are estimated 34.2 million people living with Epidemiologically HIV and HBV have common routes
HIV/AIDS worldwide, and sub-Saharan Africa remains of transmission, hence the frequent occurrence of their
the region most affected by the global Acquired co-infections.
Immunodeficiency Syndrome (AIDS) pandemic [1]. Additionally, HIV immunosuppression may be
On the other hand Hepatitis B virus (HBV) constitutes associated with reactivation of HBV infection in
a major public health challenge in this same region of persons who have lost detectable HBsAg, or HBeAg,
the world with prevalence of >8% of the population. or developing AIDS [2] or re-infection in patients who
have lost protective anti-HBs or are progressing to
_______________________________ AIDS [3]. Human Immunodeficiency Virus (HIV) is a
*Correspondence lentivirus that infects cells of the human immune
Adeolu Sunday Oluremi, system and destroys or impairs their function. Infection
Medical microbiology and Parasitology, with this virus results in the progressive deterioration
LAUTECH, Ogbomoso, Nigeria of the immune system, leading to 'immune deficiency
Email: adsunday2012@gmail.com [5].While hepatitis is the inflammation of the liver; it
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may be caused by exposure to certain chemicals, responsible in super inducing ongoing HIV replication
autoimmune diseases, or by bacterial infections but is and HIV long-term repeated transcription by
often caused by one of several viruses [6].The hepatitis synergizing with tat-protein and T-cell activation
B virus can be transmitted through contact with signals. These findings indicate that HBx could
infected blood and other body fluids and is transmitted promote faster progression to AIDS in HBV/HIV-co-
from person to person through unprotected sexual infected individuals. Studies from the pre-HAART era
intercourse with an infected person, sharing infected did not demonstrate a significant impact of HBV
needles, or other sharp agents that break the skin [6]. carriage on HIV disease progression [12]. While HBV
Hepatitis B virus and HIV have been associated with does not seem to influence HIV disease progression,
reduced survival, increase risk of progress to liver there is overwhelming evidence that HIV impacts very
disease and hepatotoxicity associated with anti- negatively on the HBV natural infections. This
retroviral therapy. Hepatitis B virus and HIV share the includes: (i) Increase in progression to HBV chronic
same routes of transmission; as a consequence, carriage; (ii) Reduced persistence of anti-HBs and anti-
infection with HBV is expected in HIV infected HBc; (iii) Increased HBV infectivity (iv) Increased
patients. Hepatitis B virus (HBV) infection is one of transmission of HBV; and (v) Impact on liver disease
the most common infections in the world, with and (vi)occult hepatitis B infections diagnosis [4].
approximately 2 billion people infected [7] Studies have shown that HIV/AIDS individuals co-
HBV exhibits a mutation rate more than 10-fold higher infected with HBV are less likely to clear acute HBV
than other DNA viruses and more closely resembles infection spontaneously, resulting to chronic infection.
the replication characteristics of RNA viruses like HIV This study therefore aims to determine the prevalence
[8]. This leads to a high mutation rate and constant and demographics characteristics of HBV infection
production of new viral variants, even in the absence of among HIV infected individuals in Ikole Ekiti, Nigeria.
antiviral treatment. The rate at which nucleotide
substitutions develop varies at different stages of Materials and methods
infection. The natural evolutionary rate for the HBV
genome in chronic hepatitis B is approximately 1.4 - The study was conducted in IHVN Clinic, Specialist
3.2 x 10-5 substitutions per site per year, which is Clinic, Ikole Ekiti, and Medical Microbiology and
approximately the same as retroviruses (10−5) but 104 Parasitology Laboratory, Laboratory complex, Osogbo,
times higher than DNA genomes [9] The high Nigeria. Ethical approval was obtained from Permanent
mutations lead to complex mixtures of genetic variants, Secretary, Ministry of Health, Ekiti State. A total of
also known as “quasispecies,” which result from this 158 consecutive patients with HIV infection seen at the
high-level, low-fidelity replication, and circulate in Specialist Hospital, Ikole Ekiti, Nigeria were selected
various reservoirs specific to each virus. for the study. Information was obtained with the aid of
Under the selective pressure of antiviral therapy that an interviewer-administered questionnaire. Status of
does not profoundly suppress viral replication; drug- serological markers for HIV and HBV (HBsAg) were
resistant strains are selected for as the dominant determined using Enzyme-linked Immunosorbent
species, with the potential loss of virological Assay (ELISA).HIV screening was done using the
suppression. Both viruses have rapid development of national algorithm; i.e., using
drug-resistant viral variants during suboptimal therapy, DETERMINE TM (manufactured by ABBOTT CO
and it’s because of both the high rate of replication and LTD, MINATO-KU, JAPAN) and STAT
turnover of virus (HIV produces ~ 10 billion new viral PAK TM (manufactured by CHEMBIO DIAGNOSTIC
particles per day while HSV produces at least 10 times SYSTEMS INC, USA) techniques and a third test
that number in each infected individual) [10] and the GENIE II test served as a tie breaker if there were
high error rate of the HIV reverse transcriptase and discordant results with the first two tests. HBsAg test
HBV polymerase enzymes. As a result of similar was done using First Response HBsAg Card Test,
polymerase enzyme, HBV and HIV share a number of manufactured by PMC Medical (India) Pvt. Ltd.
antiviral drugs, and hence the development of similar Kachigam Daman (UT) 396215, India. CD 4 Count
antiviral resistance patterns during antiviral therapy. Estimations were done using Cyflow SL-Green,
There is overwhelming evidence that HIV co-infection manufactured by Patex, Germany. Study centre is
impacts very negatively in the modification of the Medical Microbiology and Parasitology Laboratory,
natural history of HBV infections [4]. However, there Laboratory complex, LAUTECH, Osogbo, Nigeria.
has not been any convincing evidence that showed Data were analysed using statistical package within the
HBV to impact the course of HIV disease [11]. Other Microsoft Excel and SPSS software to determine the
studies have also suggested HBV protein (HBx) being effect of sex, age, CD4 count and Liver enzymes on the
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Asian Pac. J. Health Sci., 2014; 1(4): 507-511 e-ISSN: 2349-0659, p-ISSN: 2350-0964
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data obtained. P < 0.05 was considered to be years. Out of 9 patients, 8 patients (88.9%) fell within
significant. the age range 30-49 years which implies the high
prevalence of HIV among adult while 1 patient
Results (11.1%) fell within the range of 50-60 years.
The entire patients had normal ALT and AST except
Among the study subjects, there were fourty males one. Five (3.2%), 3 (1.9%) and 1 (0.6%) fell within the
(25.3%) and One hundred and eighteen females CD4 of greater than 500, 200-499 and < 200 cells/mm3
(74.7%) as shown in table 4.1. These patients aged respectively as shown in table 1. Table 4.1also showed
between 3-82 years with mean age was 35 years. One the distribution of the human immunodeficiency virus
hundred and twenty four (83.2%) patients fell within (HIV) infected in study participant as per Centers for
the age range 30-49 which implies the high prevalence Diseases Control (CDC) classification for HIV infected
of HIV among adult. Mean and median CD4 T adults and adolescents with the mean CD4 lymphocyte
lymphocyte count of the study participants were count in each category. Fifty four patients (36.2%) had
210/mm3 and 142/mm3 respectively. CD4 count of more than 500 cell/mm3, 68 patients
HBsAg is the main serological marker for diagnosis of (45.6%) had CD4 count ranging from 7- 56 cells/mm3
HBV infection as it indicates either an active or chronic and 27 patients (18.2%) had CD4 count of less than
state, this study detected nine patients were positive for 200 cells/mm3.
HBsAg and later confirmed with ELISA and therefore
the prevalence of HBV infection was 5.7%. Among the
study subjects, there were 3 males (1.9%) and 6
females (3.8%). These patients aged between 28-54
years, mean age was 35.5 years and median age was 36

Table 4.1: The baseline characteristics of HBV negative and positive patients
Parameters HBV -Ve(149) HBV +ve (9) All patient(158)
Sex
Male 37(24.8%) 3(33.3%) 40
Female 112(75.2%) 6(66.7%) 118
Age
<20 8(5.4% ) 0 8
20-29 1(0.67 %) 0 1
30-49 124(83.3 %) 8(88.9%) 132
>50 16(10.7 %) 1(11.1 %) 0
Mean 35yrs 36yrs 35.5yrs
Range 3-82yrs 28-54yrs 3-82yrs
CD4
>500 54((36.2 %) 5(55.6 %) 59
200-499 68(45.6%) 3(33.3%) 71
<200 27(18.2 %) 1(11.1 %) 28
Table 4.2: Classified alaline transaminase (ALT) and aspartate transaminase (AST) of the patients into three
(3) groups. 143 (95.6%) had normal ALT and 6 (4.4%) had raised ALT while 130 (87.5%) showed normal
AST and 19 (12.8%) showed higher AST
Parameters HBV –Ve (149) HBV +Ve (9) All Patients
ALT(IU/L)
<7 3(2.01%) 1(11.1%) 4
7-56 140(94.0%) 8(88.9%) 148
>56 5(4.02%) 1 6
AST(IU/L)
1-4 0 0 0
5-40 130(87.25%) 9(100%) 148
>40 19 0 19

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Asian Pac. J. Health Sci., 2014; 1(4): 507-511 e-ISSN: 2349-0659, p-ISSN: 2350-0964
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shown in Table 4 3. Sixteen (10.7%) of patients were
The distribution of the study participants according to of age greater than 50 years, 8 (5.4%) of teenager and
the 1993 Revised Classification System for HIV no children was affected. All 158 serum samples was
Infection and Expanded Surveillance Case Definition confirmed HIV positive.
for AIDS among Adolescents and Adults were as

Table 4.3: The distribution of the human immunodeficiency virus (HIV) infected in study participant as per
Centers for Diseases Control (CDC) classification for HIV infected adults
Category CD4 No of Patients Mean CD4 count

1 T cells >500cells/mm3 59 118.36

2 T cell 200-499cells/mm3 71 32.24

3 T cells <200 cells/mm3 28 32.11

Mean serum ALT and AST level among participants infection, P = (0.048, 0.032).The mean CD 4 count for
with HIV alone were (42.0, 38.2) International Units HIV/HBV co-infected participants (259.7 cell/mm3)
(IU), and this was significantly higher (57.6, 43.0) was significantly higher than that for participants with
International Units (IU) for those with HIV/HBV co- HIV alone (230.0 cell/mm3), P = 0.024.

Table 4.4: Compares the liver enzymes and CD4 count of the HIV with HIV- HBV coinfected patients
Characteristic (mean) HIV only, n=149 HIV/ HBV, n=9 P value
Age (years) 34 39 0.34
ALT (IU/L) 220 389 0.024
AST (IU/L) 42.0 57.6 0.048
CD4 (cell/mm3) 38.2 43 0.032
HIV: Human immunodeficiency virus, HBV: Hepatitis B virus, ALT: Alanine transaminase, AST: Aspartate
Transaminase

Discussion prevalence rate than females in both rural and urban

areas with observation that male sex was an important
From this study, the prevalence of HBV co-infections risk factor for HBV positivity. The statistically
among HIV infected individuals in Ikole Ekiti, Ekiti significant difference in HIV- HBV co-infections
State; South-Western, Nigeria is 5.7%. The observed between males and females in the present study
prevalence rate of 5.7% in HIV infected individuals suggests that they were not equally exposed to HBV-
attending the IHVN clinic may be due to rural location HIV in corroboration to earlier findings [13].
of the site of the study but it is however an indication A prevalence of 5.7% was found among HIV patients
of the rising prevalence of HBV infection in this attending Specialist hospital, Ikole Ekiti, Nigeria were
environment. This 5.7% value reported in this study is seropositive for hepatitis B virus which may probably
lower than the 9.7% by Ejele et al in the Niger Delta be a pointer to the fact that HBV infection is the major
area of Nigeria, 11.9% reported by Otegbayo et al. threat to the HIV infected patients as a result increase
(2008) in Ibadan, 16.7% reported by Idoko et al in Jos hepatotoxicity after initiation of antiretroviral therapy.
and 25.0% by Uneke et al. (2005) among HIV-infected Therefore, HIV infected patients should be screened
in Nigeria. for as well as vaccinated against HBV infection prior to
The differences in prevalence in these studies could be the initiation of antiretroviral therapy. There should
attributed to differences in patient selection. Gender- also be more awareness and campaign on HBV
specific prevalence showed that females had higher infection prevention.
seropositivity for HIV- HBV co-infections (3.8%) than Baseline ALT was significantly higher among
their male counterparts with (1.9%) prevalence. This HIV/HBV co-infected participants compared to those
observation however, disagrees with the report by with HIV alone and this is in agreement with the
Mehmet et al. (2005) in which males had higher findings of Zhou et al., 2007 [14]. There was an
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Source of Support: NIL

Conflict of Interest: None

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