Prevalence and risk factors for human immunodeficiency virus infection in pregnant women in Eastern Ghana

LETTER TO THE EDITOR

Prevalence and risk factors for human immunodeficiency virus infection in pregnant women in Eastern Ghana

Hee Jung Yoon^I; George Bonsu^II; Arko Akoto-Ampaw^III; Grace Nkrumah-Mills^IV; Julia J.A. Nimo^V; Jin Kyung Park^VI; Moran Ki^VII,*

^IDivision of Infectious Diseases, Department of Internal Medicine, Eulji University School of Medicine, Daejeon, Korea

^IIEastern Region Public Health Services (PHS), Koforidua, Eastern Province, Ghana

^IIIAsesewa District Hospital, Upper Manya Krobo, Eastern Province, Ghana

^IVYilo Krobo PHS (Somanya Polyclinic), Somanya, Eastern Province, Ghana

^VKwahu West PHS (Holy Family Hospital), Kwahu West, Eastern Province, Ghana

^VITranslational Research Division, International Vaccine Institute, Seoul, Korea

^VIIDepartment of Preventive Medicine, Eulji University School of Medicine, Daejeon, Korea

Dear Editor,

Determining HIV incidence is a useful tool for improving the targeting of populations for interventions and assessing the effectiveness of prevention strategies. A reduction in perinatal transmission of HIV is dependent on women seeking prenatal care, having access to an HIV test, agreeing to interventions such as antiretroviral therapy, and considering alternatives to breastfeeding. Thus, the aim of this study was to determine the seroprevalence and risk factors for human immunodeficiency virus (HIV) positivity among pregnant women in Eastern Ghana.

Between December 2008 and March 2009, a total of 1,500 apparently healthy pregnant women who visited three hospitals in Eastern Ghana - Asesewa Government Hospital (AGH) in Upper Manya Krobo district, Holy Family Hospital (HFH) in Kwahu West district, and Somanya Polyclinic (SPC) in Yilo Krobo district - were consecutively recruited for this study after obtaining their informed consent. At every visit a standardized questionnaire was interview-administered to obtain data on socio-demographics, reproductive history, job status, social support, mental health, and health care utilizations. HIV, hepatitis B surface antigen (HBsAg), hemoglobin and sickling tests were done as a prenatal check-up. Univariate and multivariate odds ratios (OR), both with 95% confidence interval (CI), were calculated.

A total of 1,109 apparently healthy pregnant women with a mean age of 26.85 ± 6.71 years were screened. Overall HIV positive rate was 8.0%. The risk factors associated with acquisition of HIV-1 in univariate analyses were older age, HBsAg positive status, and substantial alcohol use. These factors were analyzed in multiple logistic regression analysis. Age groups 25-29 (OR 2.770; 95% CI; 1.023-7.499) and > 35 (OR 3.141; 95% CI; 1.131-8.723), and HBsAg positive status (OR 2.376; 95% CI; 1.261-4.476) remained significantly associated with acquisition of HIV (Table 1).

HIV prevalence among young pregnant women (15-24 years) is used as a proxy for measuring the rate of new infections in a population.¹ In contrast, in this study, women aged 25-29 years were 2.77 times more likely to be infected than women of < 20 age. This suggests that women who are at the peak of their reproductive years are more prone to HIV infection. Due to shared routes of transmission, a frequent occurrence of HIV/hepatitis co-infections seems likely. In countries with high hepatitis B virus (HBV) endemicity such as Ghana (> 8% affected)², the principal routes of HBV transmission are perinatal or in early childhood; thus, HBV infection usually precedes HIV infection by decades. In these countries, the majority of studies show HBV coinfection prevalence of 10-20%.³ This study found 14.7% HIV seropositivity prevalence rate among the HBsAg positive pregnant women. HIV infection negatively impacts all phases of the natural course of hepatitis B. The goals of HIV treatment during pregnancy are to optimize the mother's health and to minimize the risk of vertical transmission. Therefore, determining the HIV status of pregnant women is a key factor to the success of any prevention program. Especially, focusing on the patients with high risk can save money in resource-limited countries. Facilities for early infant diagnosis using molecular techniques will help in the identification of infected children for support. As always, prevention is better than cure.

Conflict of interest

All authors declare to have no conflict of interest.

Acknowledgements

This work was carried out for the program "Support for Mother and Child Health Care in Eastern Region, Ghana" which was supported by the KOICA.

Received 12 October 2011

Accepted 3 November 2011

• 1. Federal Ministry of Health (Nigeria). Report on the 2008 National HIV seroprevalence sentinel survey among pregnant women attending antenatal clinics in Nigeria. Federal Ministry of Health; 2009;1-46.
• 2. Merrill RM, Hunter BD. Seroprevalence of markers for hepatitis B viral infection. Int J Infect Dis. 2011;15(2):e78-121.
• 3. Harania RS, Karuru J, Nelson M, et al. HIV, hepatitis B and hepatitis C co-infection in Kenya. AIDS. 2008;22:1221-1222.

Publication Dates

• Publication in this collection
  25 Apr 2012
• Date of issue
  Apr 2012