The prevalence of hepatitis B virus infection markers and socio-demographic risk factors in HIV-infected patients in Southern Brazil

Martins, Saulo; Livramento, Andréa do; Andrigueti, Michelle; Kretzer, Iara Fabricia; Machado, Marcos José; Spada, Celso; Treitinger, Aricio

doi:10.1590/0037-8682-0109-2014

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Major Articles • Rev. Soc. Bras. Med. Trop. 47 (5) • Oct 2014 • https://doi.org/10.1590/0037-8682-0109-2014 copy

The prevalence of hepatitis B virus infection markers and socio-demographic risk factors in HIV-infected patients in Southern Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Introduction

Hepatitis B virus (HBV) and human immunodeficiency virus (HIV) infections are two of the world's most important infectious diseases. Our objective was to determine the hepatitis B surface antigen (HBsAg) and hepatitis B core antibody (anti-HBc) prevalences among adult HIV-infected patients and identify the associations between socio-demographic variables and these HBV infection markers.

Methods

This study was performed from October 2012 to March 2013. Three hundred HIV-seropositive patients were monitored by the Clinical Analysis Laboratory of Professor Polydoro Ernani de São Thiago University Hospital, Santa Catarina, Brazil. The blood tests included HBsAg, anti-HBc immunoglobulin M (IgM) and total anti-HBc. Patients reported their HIV viral loads and CD₄+ T-cell counts using a questionnaire designed to collect sociodemographic data.

Results

The mean patient age was 44.6 years, the mean CD4 T-cell count was 525/mm³, the mean time since beginning antiretroviral therapy was 7.6 years, and the mean time since HIV diagnosis was 9.6 years. The overall prevalences of HBsAg and total anti-HBc were 2.3% and 29.3%, respectively. Among the individuals analyzed, 0.3% were positive for HBsAg, 27.3% were positive for total anti-HBc, and 2.0% were positive either for HBsAg or total anti-HBc and were classified as chronically HBV-infected. Furthermore, 70.3% of the patients were classified as never having been infected. Male gender, age >40 years and Caucasian ethnicity were associated with an anti-HBc positive test.

Conclusions

The results showed an intermediate prevalence of HBsAg among the studied patients. Moreover, the associations between the anti-HBc marker and socio-demographic factors suggest a need for HBV immunization among these HIV-positive individuals, who are likely to have HIV/HBV coinfection.

Prevalence; Hepatitis B; Human immunodeficiency virus; Coinfection; Brazil

Gender	HBsAg (-) Total anti-HBc (-)		HBsAg (-) Total anti-HBc (+)		HBsAg (+) Total anti-HBc (-)		HBsAg (+) Total anti-HBc (+)		Total
Gender	n	%	n	%	n	%	n	%	n	%
Male	109	36.3	64	21.4	1	0.3	5	1.7	179	59.7
Female	102	34.0	18	6.0	-	-	1	0.3	121	40.3
Total	211	70.3	82	27.3	1	0.3	6	2.0	300	100.0

Variable	HBsAg					Total
	negative		positive		p-value	Total
	n	%	n	%	p-value	n	%
Age (years)
≤40	98	97.0	3	3.0	0.907	101	33.7
>40	195	98.0	4	2.0	0.907	199	66.3
Gender
male	173	96.6	6	3.4	0.155	179	59.7
female	120	99.2	1	0.8	0.155	121	40.3
Ethnicity
caucasian	252	97.7	6	2.3	0.982	258	86.0
non-caucasian	41	97.6	1	2.4	0.982	42	14.0
Highest level of education
<high school	171	97.7	4	2.3	0.948	175	58.3
≥high school	122	97.6	3	2.4	0.948	125	41.7
Monthly income (US$)
<1,300	196	97.5	5	2.5	0.801	201	67.0
≥1,300	97	98.0	2	2.0	0.801	99	33.0
Time since HIV infection diagnosis (years)
<10	155	96.9	5	3.1	0.332	160	53.3
≥10	138	98.6	2	1.4	0.332	140	46.7
Time since the initiation of antiretroviral therapy (years)
<10	183	97.3	5	2.7	0.628	188	62.7
≥10	110	98.2	2	1.8	0.628	112	37.3
Transmission route of HIV infection
MSM	65	95.6	3	4.4	0.856	68	22.7
heterosexual	183	98.9	2	1.1		185	61.7
IDU	32	94.1	2	5.9		34	11.3
others	13	100.0	-	-		13	4.3
HIV viral load (copies/mL)
<50	224	97.8	5	2.2	0.847	229	76.4
50 to 10,000	45	97.8	1	2.2		46	15.3
>10,000	24	96.0	1	4.0		25	8.3
CD4 T-cell count (cells/mm³)
<500	150	98.0	3	2.0	0.478	153	51.0
≥500	143	97.3	4	2.7	0.478	147	49.0

Variable	Anti-HBc					Total
	negative		positive		p-value	Total
	n	%	n	%	p-value	n	%
Age (years)
≤40	84	83.2	17	16.8	0.001^* * Statistically significant at p<0.050.	101	33.7
>40	128	64.3	71	35.7	0.001^* * Statistically significant at p<0.050.	199	66.3
Gender
male	110	61.5	69	38.5	<0.001^* * Statistically significant at p<0.050.	179	59.7
female	102	84.3	19	15.7	<0.001^* * Statistically significant at p<0.050.	121	40.3
Ethnicity
caucasian	177	68.6	81	31.4	0.049^* * Statistically significant at p<0.050.	258	86.0
non-caucasian	35	83.3	7	16.7	0.049^* * Statistically significant at p<0.050.	42	14.0
Highest level of education
<high school	128	73.1	47	26.9	0.265	175	58.3
≥high school	84	67.2	41	32.8	0.265	125	41.7
Monthly income (US$)
<1,300	150	74.6	51	25.4	0.032^* * Statistically significant at p<0.050.	201	67.0
≥1,300	62	62.6	37	37.4	0.032^* * Statistically significant at p<0.050.	99	33.0
Time since HIV infection diagnosis (years)
<10	115	71.9	45	28.1	0.623	160	53.3
≥10	97	69.3	43	30.7	0.623	140	46.7
Time since initiation of antiretroviral therapy (years)
<10	137	72.9	51	27.1	0.277	188	62.7
≥10	75	67.0	37	33.0	0.277	112	37.3
Transmission route of HIV infection
MSM	44	64.7	24	35.3	0.005^* * Statistically significant at p<0.050.	68	22.7
heterosexual	139	75.1	46	24.9		185	61.7
IDU	17	50.0	17	50.0		34	11.3
other	12	92.3	1	7.7		13	4.3
HIV viral load (copies/mL)
<50	157	68.6	72	31.4	0.269	229	76.4
50 to 10,000	37	80.4	9	19.6		46	15.3
>10,000	18	80.0	7	20.0		25	8.3
CD4 T-cell count (cells/mm³)
<500	109	71.2	44	28.8	0.461	153	51.0
≥500	103	70.1	44	29.9	0.461	147	49.0

Variable	OR (95%CI)	p-value
Age(years)
>40	2.9047 (1.5459 to 5.4577)	0.0009^* * Statistically significant at p<0.050.
Ethnicity
Non-caucasian	0.3539(0.1448 to 0.8050)	0.0027^* * Statistically significant at p<0.050.
Gender
Female	0.2825 (0.1555 to 0.5134)	<0.0001^* * Statistically significant at p<0.050.

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[1] Address to: Dr. Aricio Treitinger. Dept^o de Análises Clínicas/CCS/UFSC. Campus Universitário Trindade, 88040-900 Florianópolis, SC, Brasil. Phone: 55 48 3721-9712; 55 48 3721-3468. e-mail: aricio.treitinger@ufsc.br