Prevalence, risk factors and genotypes of hepatitis B infection among HIV-infected patients in the State of MS, Central Brazil

Freitas, Solange Zacalusni; Soares, Caroline Cordeiro; Tanaka, Tayana Serpa Ortiz; Lindenberg, Andréa Siqueira Campos; Teles, Sheila Araújo; Torres, Marina Sawada; Mello, Francisco Campello Amaral; Mendes-Corrêa, Maria Cássia; Savassi-Ribas, Flávia; Motta-Castro, Ana Rita Coimbra

doi:10.1016/j.bjid.2014.01.005

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Original Articles • Braz J Infect Dis 18 (5) • Sept-Oct 2014 • https://doi.org/10.1016/j.bjid.2014.01.005 copy

Prevalence, risk factors and genotypes of hepatitis B infection among HIV-infected patients in the State of MS, Central Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objectives:

A cross-sectional study on prevalence of HBV and HDV infection, risk factors and genotype distribution of HBV infection was conducted among 848 HIV-infected patients in Mato Grosso do Sul, Central Brazil.

Methods:

Serum samples of 848 participants were tested for hepatitis B surface antigen (HBsAg), hepatitis B core antibody (anti-HBc) and hepatitis surface antibody (anti-HBs). HBsAg positive samples were tested for anti-HBc IgM, HBeAg, anti-HBe, anti-HCV, and total anti-HDV. HBsAg and anti-HBc positive were subjected to DNA extraction. Viral DNA was amplified by semi-nested PCR for the regions pre-S/S and then purified and genotyped/subgenotyped by direct sequencing. Student's t-test, chi-square test and Fisher's exact test were used to compare variables and to evaluate association between HBV positivity (defined as anti-HBc and/or HBsAg positivity) and risk factors.

Results:

Among the 848 HIV infected patients investigated 222 had serological markers of HBV infection. The prevalence rate of HIV-HBV coinfection was 2.5% (21/848; 95% CI: 1.4–3.5%); 484 (57.1%) patients were susceptible for HBV infection. There were no cases of anti-HDV positive and only one (0.1%) anti-HCV-positive case among the HIV-HBV coinfected patients. Male gender, increasing age, family history of hepatitis, use of illicit drug, and homosexual activity were independent factors associated with HBV exposure. The phylogenetic analysis based on the S gene region revealed the presence of genotypes D (76.9%), F (15.4%) and A (7.7%) in the study sample.

Conclusion:

This study demonstrates the low prevalence of HIV-HBV infection and also highlights the need for early vaccination against HBV as well as testing for HBV, HCV and HDV in all HIV-infected individuals.

Coinfection; HBV; HIV; Prevalence

Primers	Nt position^a a Nucleotides (nt) are numbered starting at the cleavage site for the restriction enzyme, EcoRI, located in the pre-S2 region of the full-length (3221 bp) HBV genotype A genome. HBV, hepatitis B virus; PCR, polymerase chain reaction.	Sequences
PS1 (sense)	Nt 2826–2845	5'-CCA TAT TCT TGG GAA CAA GA-3'
P3 (antisense)	Nt 1019–1000	5'-AAA GCC CAA AAG ACC CAC AA-3'
S2 (antisense)	Nt 841–819	5'-GGG TTT AAA TGT ATA CCC AAA GA-3'
S22 (antisense)	Nt 841–819	5'-GTA TTT AAA TGG ATA CCC ACA GA-3'
PS4 (sense)	Nt 3194–3218	5'-ACA CTC ATC CTC AGG CCA TGC AGT G-3'
PS2 (antisense)	Nt 143–124	5'-GGT CCC CAG TCC TCG AGA AG-3'
S4 (sense)	Nt 416–436	5'-TGC TGC TAT GCC TCA TCT TCT-3'

Variable		n	%
Gender
	Female	365	43.0
	Male	483	57.0
Age (years)
	≤25	55	6.5
	26–35	202	23.8
	36–45	296	34.9
	46–55	207	24.4
	>55	88	10.4
Partnership
	With a steady partner	377	44.5
	Without a steady partner	471	55.5
Race/ethnicity
	White	470	55.4
	Brunette skin/Brown	265	31.3
	Black	113	13.3
Education level
	Illiterate	37	4.4
	Primary	446	52.6
	Secondary	253	29.8
	University	112	13.2
Place of birth
	MS	551	65.0
	Other states	297	35.0
Family income (minimum wage^a a Minimum wage: approximately US$ 300.00 per month. )
	<1	77	9.1
	1–3	635	74.9
	≥4	136	16.0
Number of people per household
	1	139	16.4
	2–4	580	68.4
	5–10	123	14.5
	>10	6	0.7
Religion
	No religion	117	13.9
	Catholic	387	45.6
	Evangelical	287	33.8
	Others	57	6.7

Category	Serological marker	Positive		95% CI^a a CI, confidence interval.
Category	Serological marker	n	%	95% CI^a a CI, confidence interval.
	HBsAgg	21	2.5	1.4–3.5
	Alone anti-HBc	47	5.5	4.0–7.1
HBV infection	Anti-HBc/anti-HBs	154	18.2	15.6–20.8
	Any infection marker	222	26.2	23.3–29.3
Not exposed, possibly vaccinated	Alone anti-HBs	142	16.7	14.2–19.3
Not exposed, susceptible	Absence of marker	484	57.1	53.7–60.4
Total		848	100.0

Variable		HBV Positive/total	%	Odds ratio (95% CI^b b CI: 95% confidence interval. )	p	Adjusted Odds ratio (95% CI)	p
Gender
	Female	60/292	20.5	1.0		1.0
	Male	162/414	39.1	2.49 (1.76–3.51)	<0.01	1.97 (1.32–2.94)	<0.01
Age (years)
	<25	3/37	8.1	1.0		1.0
	26–35	28/170	16.5	2.23 (0.64–7.79)	0.30	2.31 (0.63–8.47)	0.21
	36–45	83/242	34.3	5.91 (1.76–19.83)	<0.01	6.23 (1.77–22.0)	<0.01
	46–55	71/180	39.4	7.38 (2.18–24.94)	<0.01	8.85 (2.48–31.57)	<0.01
	> 55	37/77	48.1	10.48 (2.97–37.04)	<0.01	15.82 (4.2–59.53)	<0.01
Partnership						–
	With a steady partner	78/310	25.2	1.0		1.0
	Without a steady partner	144/396	36.4	1.70 (1.22–2.36)	<0.01	1.26 (0.86–1.84)	0.23
Education level
	University + Secondary	92/285	32.2	1.0		1.0
	Primary	114/388	29.3	0.87 (0.62–1.21)	0.47	0.96 (0.64–1.42)	0.82
	Illiterate	16/33	48.4	1.97 (0.95–4.08)	0.10	1.66 (0.74–3.72)	0.22
Hepatitis in the Family
	No	172/589	29.2	1.0		1.0
	Yes	50/117	42.7	1.81 (1.20–2.72)	<0.01	2.03 (1.30–3.20)	<0.01
Use of illicit drug
	No	166/570	29.1	1.0		1.0
	Yes	56/136	41.2	1.70 (1.16–2.51)	<0.01	1.66 (1.08–2.56)	0.02
Detention
	No	181/607	29.8	1.0		1.0
	Yes	41/99	41.4	1.66 (1.08–2.57)	0.02	1.08 (0.63–1.83)	0.79
Sexual orientation
	Heterosexual	159/581	27.4	1.0		1.0
	Homosexual/Bisexual	63/125	50.4	2.70 (1.82–4.00)	<0.01	2.67 (1.70–4.22)	<0.01
Anal sex
	No	154/553	27.8	1.0		1.0
	Yes	68/153	44.4	2.07 (1.43–3.00)	<0.01	1.11 (0.61–2.03)	0.73
Number of sexual partners in last year
	None or 1	150/510	29.4	1.0		1.0
	2–5	57/156	36.5	1.38 (0.94–2.01)	0.11	1.08 (0.70–1.68)	0.73
	> 5	15/40	37.5	1.44 (0.73–2.80)	0.37	0.78 (0.38–1.64)	0.52
HCV seropositivity
	No	198/655	30.2	1.0
	Yes	24/51	47.1	2.05 (1.55–3.64)	<0.01	1.23 (0.64–2.38)	0.53

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[1] *Corresponding author at: Avenida Senador Filinto Mueller, s/n, CCBS, Cidade Universitária, 79070-900, Campo Grande, MS, Brazil. E-mail address: zacalusni@yahoo.com.br (S.Z. Freitas).