Viral Hepatitis and Rapid Diagnostic Test Based Screening for HBsAg in HIV-infected Patients in Rural Tanzania |
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| Authors: | Fabian C Franzeck Ramadhani Ngwale Bernadeta Msongole Marian Hamisi Omary Abdul Lars Henning Emilio Letang Geoffrey Mwaigomole Manuel Battegay Christoph Hatz Marcel Tanner |
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| Institution: | 1. Swiss Tropical and Public Health Institute, Basel, Switzerland.; 2. Ifakara Health Institute, Ifakara, Tanzania.; 3. University of Basel, Basel, Switzerland.; 4. Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland.; 5. St. Francis Referral Hospital, Ifakara, Tanzania.; 6. Barcelona Centre for International Health Research, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.; Ghent University, Belgium, |
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| Abstract: | BackgroundCo-infection with hepatitis B virus (HBV) is highly prevalent in people living with HIV in Sub-Saharan Africa. Screening for HBV surface antigen (HBsAg) before initiation of combination antiretroviral therapy (cART) is recommended. However, it is not part of diagnostic routines in HIV programs in many resource-limited countries although patients could benefit from optimized antiretroviral therapy covering both infections. Screening could be facilitated by rapid diagnostic tests for HBsAg. Operating experience with these point of care devices in HIV-positive patients in Sub-Saharan Africa is largely lacking. We determined the prevalence of HBV and Hepatitis C virus (HCV) infection as well as the diagnostic accuracy of the rapid test device Determine HBsAg in an HIV cohort in rural Tanzania.MethodsProspectively collected blood samples from adult, HIV-1 positive and antiretroviral treatment-naïve patients in the Kilombero and Ulanga antiretroviral cohort (KIULARCO) in rural Tanzania were analyzed at the point of care with Determine HBsAg, a reference HBsAg EIA and an anti-HCV EIA.ResultsSamples of 272 patients were included. Median age was 38 years (interquartile range IQR] 32–47), 169/272 (63%) subjects were females and median CD4+ count was 250 cells/µL (IQR 97–439). HBsAg was detected in 25/272 (9.2%, 95% confidence interval CI] 6.2–13.0%) subjects. Of these, 7/25 (28%) were positive for HBeAg. Sensitivity of Determine HBsAg was rated at 96% (95% CI 82.8–99.6%) and specificity at 100% (95% CI, 98.9–100%). Antibodies to HCV (anti-HCV) were found in 10/272 (3.7%, 95% CI 2.0–6.4%) of patients.ConclusionThis study reports a high prevalence of HBV in HIV-positive patients in a rural Tanzanian setting. The rapid diagnostic test Determine HBsAg is an accurate assay for screening for HBsAg in HIV-1 infected patients at the point of care and may further help to guide cART in Sub-Saharan Africa. |
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