The prevalence of Hepatitis B and/or Hepatitis C virus (HBV and/or HCV) co-infection among HIV-infected pregnant women

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JULY, 2015
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Hepatitis B virus (HBV) and/or hepatitis C virus (HCV) infection(s) among people living with human immunodeficiency virus (HIV) is a growing problem. Liver disease resulting from hepatitis B or hepatitis C virus infection has become one of the main causes of morbidity and mortality among persons living with HIV worldwide. Co-infections are known to increase the risk of vertical transmission of these viruses. Various research works have provided varying information on the prevalence and risk factors for HBV and/or HCV co-infection among pregnant women. Very little information on this subject exists in Ghana. Aims This study sought to determine the prevalence and risk factors associated with HBV and/or HCV co-infection among HIV infected pregnant women. It also sought to investigate the immunological and virological characteristics associated with the co-infection and the use of antiretroviral drugs among the HIV-infected participants. Methods This study was conducted at the antiretroviral therapy and antenatal clinics of the St. Elizabeth Hospital, Hwidiem and the Holy Family Hospital Techiman in the Brong-Ahafo Region of Ghana between May 2012 and May 2013. A total of 124 participants including 74 HIV-infected, and 50 HIV-negative, pregnant women were enrolled. The full blood count and the CD4 count of eligible participants were determined using Sysmex KX N21 haematology analyzer (Japan) and BD Facs Count analyzer (USA) respectively. The hepatitis B profile and anti-HCV status of participants were determined using Wondfo Biotech test-kits. The HIV-I viral load of the HIV positive participants was determined close to the time of delivery using COBAS® AmpliPrep/COBAS® TaqMan Analyzer (USA). Results The prevalence of HBV infection among the HIV-infected participants was higher than observed among the HIV-negative participants (14.9% vrs 10%). However, the prevalence of antibodies to the hepatitis C virus (anti-HCV) was lower among the HIV-infected pregnant women as compared to their HIV-negative counterparts (4.1% vrs 12%). None of the participants had a triple infection of HIV/HBV/HCV. There was no significant difference between the co-infection status and the baseline CD4 count as well as the HIV-1 viral load close to the time of delivery. However, persons who were diagnosed of HIV-infection in the third trimester of pregnancy were significantly at risk of having high HIV viral load close to the time of delivery (p= 0.009). HBeAg positivity was associated with severe immunosuppression (mean CD4=185± 10). HIV/HBV co-infected participants were significantly less likely to seroconvert from HBeAg to anti-HBe (p= 0.003). Conclusion HIV/HBV and HIV/HCV co-infections are high among HIV-infected pregnant women. Making ARVs available alone may not lead to the desired results. Priority must be given to early diagnosis and initiation of ARV prophylaxis for HIV infected pregnant women.
A thesis submitted to the School of Graduate Studies, Kwame Nkrumah University of Science and Technology in partial fulfillment of the requirements for the award of the Degree of Master of Philosophy in Immunology,