A E O Otedo1. 1. Kisumu District Hospital, P. O. Box 4685, Kisumu, Kenya.
Abstract
BACKGROUND: Patients with dual infection of HBV and HIV are increasingly being recognised. The two viruses, HBV and HIV share the same route of transmission and HBV is more efficiently transmitted than HIV. There is evidence that HBV will contribute significantly to continuing morbidity and mortality within the HIV infected population over the coming years. This is due to the widespread use/accessibility of the highly active anti-retroviral (HAART) drugs hence patients live longer. There are few published data in the tropical region on these patients especially in regions where HBV and HIV are endemic. OBJECTIVES: To determine the prevalence of HBV, HIV co-infection in patients who presented with jaundice and the pattern of CD4 cell counts in these patients. DESIGN: A prospective, cross-sectional, descriptive study of all consecutive patients included in the study. SETTING: Medical wards, medical outpatient clinic and liver clinic, Kisumu District Hospital, Western Kenya. SUBJECTS: Five hundred and nineteen (261 females and 258 males) patients who had jaundice were screened for the study. One hundred and eighty five (110 males and 75 females) patients were excluded. Three hundred and thirty four patients 151 (45.2%) males and 183 (54.8%) females were included and completed the study between August 2002 and October 2003. MAIN OUTCOME MEASURES: Socio-demographic data, HBsAg positive, HIV serology (positive or negative), CD4 cell counts, ALT and AST, IgG anti-HBc and IgM anti-HBc. RESULTS: The age range was 7-76 years with a mean of 36 (+/-13) years. The mean age for males and females was 37 (+/-13) years and 35 (+/-12) years respectively. One hundred and seventy seven (53%) had co-infection and 157 (47%) had HBV mono-infection. IgG anti-HBc and IgM anti-HBc were detected in 17 (5%) and 317 (95%) patients respectively. Of the 317 patients with IgM anti-HBc, 177 (55.8%) had co-infection while 140 (44.2%) had HBV mono-infection (p=0.05). The overall mean CD4 cell count for the whole population was 391 (+/-314) cells/mm3. The mean CD4 cell count for patients with co-infection was lower, (120 (+/-112) cells/mm3) than for patients with HBV mono-infection, 694 (+/-140) cells/mm3. The transaminases were uniformly elevated in both groups with mean AST of 207 (+/-147) U/L and ALT of 356 (+/-177) U/L. In the co-infection and mono-infection groups, AST was 286 (+/-117) U/L and 306 (+/-175) U/L (p=0.23) and is not statistically significant, and the ALT was 338 (+/-135) U/L and 375 (+/-213) U/L respectively p=0.05 and the difference is statistically significant. CONCLUSION: HBV and HIV co-infection is recognised in this region, which is endemic for both viral infections. The patients with dual infection had very low CD4 cell counts. This will influence the choice of highly active anti-retroviral therapy (HAART) in favour of Lamivudine containing combinations to cover the HBV infection.
BACKGROUND:Patients with dual infection of HBV and HIV are increasingly being recognised. The two viruses, HBV and HIV share the same route of transmission and HBV is more efficiently transmitted than HIV. There is evidence that HBV will contribute significantly to continuing morbidity and mortality within the HIV infected population over the coming years. This is due to the widespread use/accessibility of the highly active anti-retroviral (HAART) drugs hence patients live longer. There are few published data in the tropical region on these patients especially in regions where HBV and HIV are endemic. OBJECTIVES: To determine the prevalence of HBV, HIV co-infection in patients who presented with jaundice and the pattern of CD4 cell counts in these patients. DESIGN: A prospective, cross-sectional, descriptive study of all consecutive patients included in the study. SETTING: Medical wards, medical outpatient clinic and liver clinic, Kisumu District Hospital, Western Kenya. SUBJECTS: Five hundred and nineteen (261 females and 258 males) patients who had jaundice were screened for the study. One hundred and eighty five (110 males and 75 females) patients were excluded. Three hundred and thirty four patients 151 (45.2%) males and 183 (54.8%) females were included and completed the study between August 2002 and October 2003. MAIN OUTCOME MEASURES: Socio-demographic data, HBsAg positive, HIV serology (positive or negative), CD4 cell counts, ALT and AST, IgG anti-HBc and IgM anti-HBc. RESULTS: The age range was 7-76 years with a mean of 36 (+/-13) years. The mean age for males and females was 37 (+/-13) years and 35 (+/-12) years respectively. One hundred and seventy seven (53%) had co-infection and 157 (47%) had HBV mono-infection. IgG anti-HBc and IgM anti-HBc were detected in 17 (5%) and 317 (95%) patients respectively. Of the 317 patients with IgM anti-HBc, 177 (55.8%) had co-infection while 140 (44.2%) had HBV mono-infection (p=0.05). The overall mean CD4 cell count for the whole population was 391 (+/-314) cells/mm3. The mean CD4 cell count for patients with co-infection was lower, (120 (+/-112) cells/mm3) than for patients with HBV mono-infection, 694 (+/-140) cells/mm3. The transaminases were uniformly elevated in both groups with mean AST of 207 (+/-147) U/L and ALT of 356 (+/-177) U/L. In the co-infection and mono-infection groups, AST was 286 (+/-117) U/L and 306 (+/-175) U/L (p=0.23) and is not statistically significant, and the ALT was 338 (+/-135) U/L and 375 (+/-213) U/L respectively p=0.05 and the difference is statistically significant. CONCLUSION: HBV and HIV co-infection is recognised in this region, which is endemic for both viral infections. The patients with dual infection had very low CD4 cell counts. This will influence the choice of highly active anti-retroviral therapy (HAART) in favour of Lamivudine containing combinations to cover the HBV infection.