Prevalence and determinants of hepatitis B virus (HBV) infection in a cohort of HIV-1 discordant couples in Western Kenya: implications for HIV care

Abstract

Background: Hepatitis B is a major global health problem with over 350 million people suffering from chronic HBV infection. Infection with HBV negatively impacts the outcome of HIV in- fection and yet there are no national clinical guidelines for diag- nosis, treatment and care for HBV-HIV co-infection. This study sought to determine the prevalence and determinants of HBV in- fection in a cohort of HIV-1 discordant couples in Western Kenya. Methods: A cross sectional study of healthy heterosexual HIV-1 discordant couples from Western Kenya referred for possible re- cruitment into the Partners PrEP Study was conducted between September 2008 and October 2010. All participants were screened for hepatitis B surface antigen (HBsAg) and socio-demographic data were collected. Descriptive statistics were used to determine frequencies while the association between HBsAg and the inde- pendent variables were evaluated using logistic regression. Results: Data on 1834 adults aged 18—64 are presented. HBsAg was positive in 77 [4.2%] individuals. Men were 40% less likely to be infected compared to women [OR 0.61; 95% CI 0.379- 0.972; p value 0.0380]. Those from rural areas were almost 2 times more likely to be infected than those from urban areas [OR 1.92; 95% CI 1.190-3.099; p value 0.008]. Hepatitis B prevalence did not differ by HIV status [HIV positive 3.9% vs negative 4.5% [OR =1.15; 95% CI of 0.725-1.810 p value =0.561]. There was also no significant correlation between hepatitis B and partici- pants’ age, alcohol intake, CD4 counts, income or level of edu- cation. Immunity to hepatitis B (as measured by the presence of antibody to HBsAg) was identified in 25.6% [469] with the ma- jority [73%] of the participants being in their 3rd and 4th decades. Conclusions: Whereas HBV vaccination should be scaled up for both adult men and women irrespective of their HIV status, more effort should be directed towards adult rural women of child bearing age especially those below 25 years.