ABSTRACT

CORRESPONDING AUTHOR
Sachin G. J.
#17, New PG Boys Hostel
Vims opd Campus, Bellary
E-mail: Sachingj80@gmail.com
Ph: 0091 9880048587

ABSTRACT: BACKGROUND: There are an estimated 4 million patients with HIV/HBV co-infection.  With introduction of newer ARV treatment HIV does not appear to significantly modify the natural history of HBV infection. Therefore, all patients with HIV/HBV co-infection should be evaluated for treatment of hepatitis B, independently of the CD4 lymphocyte count. Early detection can contribute substantially to the timely diagnosis of the patients with acute illnesses and to an early treatment and hence, it can limit the transmission of the infection AIM: This study was undertaken to know the prevalence of HBV in patients with HIV attending a community care centre in Bellary. METHODS AND MATERIAL: The prospective study included three hundred consecutive HIV infected patients attending community care centre, who were tested for co-infection with HBV. It included one hundred and seventy two male and one hundred and thirty eight female patients between the age group 25-50 years. HBV infection was detected by ELISA card method. Other routine investigations were also done. RESULTS: Out of a 300 consecutive HIV infected patients studied, HBV co-infection was detected in 22 /300 (7.5%) patients. The mode of transmission of HBV was heterosexual contact in all (100%). CONCLUSION: The prevalence of co-infection of HIV with HBV is similar in our study population as compared to that reported in other studies and depends on mode of transmission. The knowledge of HBV infection in a patient of HIV is vital since these patients, as they live longer on antiretroviral treatment will also need to be managed for their infection with HBV its complications like HCC. Hence improving preventive measures including vaccination and risk reduction, effective screening of HIV patients for HBV or HCV and evaluating the impact of chronic infection on the liver and finally along with early screening of hepatocellular carcinoma is required.
KEYWORDS: Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV), Co-infection, Prevalence

INTRODUCTION: The modes of transmission of both HBV and HIV infections being similar, the chances of co- infection is not rare event. The data from Western studies reveal the incidence of HBV co-infection as 9-12%1, 2.  The prevalence of HIV infection in India has been high when compared with rest of world and according to UNAIDS has been estimated to be around 5.7 million. The effect of HIV infection on natural history of HBV has markedly changed with the introduction of newer drugs in ARV treatment.  Initially there was negative impact of HIV on hepatotropic infections but presently HIV does not significantly modify the natural history of HBV infection.4 The immune restoration and viral suppression brought about by the nucleoside analogues having dual activity against HIV and HBV explains the above change in scenario5.  The HBV infection in HIV patients in India varies widely as this depends on the mode of transmission and the load of infection in the population.6-9 Detection of HBV infection also impacts the ARV treatment initiation in HIV patients. Hence the present study was conducted to find out the prevalence of HBV -infection in HIV patients in south India.

MATERIAL AND METHODS: This prospective study was conducted at HIV Unit of community care centre, St Mary’s hospital, Bellary involving 300 consecutive HIV positive patients. A detailed history and clinical examination were performed. The history mainly included age, sex, mode of transmission, education status, history of smoking, alcohol intake, occupation and socioeconomic status. The general examination, physical examination and systemic examination was carried out.
Blood investigations including complete haemogram, biochemistry (including - blood sugar, renal function tests, liver function tests) and CD4/ CD8 counts were carried out.
Diagnosis of HBV co-infection was made based on ELISA method.

AIM: This study was undertaken to know the prevalence of HBV in patients with HIV attending a community care centre in Bellary

RESULTS: A total of 300 consecutive HIV positive patients were studied.
Twenty two (7.5 %) patients had HBV co-infection. The clinical and epidemiological details are given in table 1.  The mode of transmission in HIV/HBV co-infection was heterosexual. The mean CD4 count was 247.1/mm3. Ten patients (45.42%) out of 22 patients (having HIV with HBV co-infection) had a CD4 count less than 200/mm3 i.e. advanced HIV disease. Significantly raised ALT was found in 2 out of 22 patients (9.09%).  Two patients had clinical abnormality including jaundice, hepatosplenomegaly and ascites.

DISCUSSION: The prevalence of HBV in HIV patients has been variably reported in various studies. In the EUROSIDA STUDY and MACS COHORT STUDY.1, 2 it was reported as 9% and 12.7% respectively. An Indian study conducted in north india had shown lower prevalence .In present study we have found a prevalence of HBV of about7.5%.
The commonest mode of transmission being sexual contact in these patients, which correlates well with data from other Indian studies.  Another study done in south India had demonstrated the prevalence of HBV to be around 7.5%11
The variation in prevalence of HBV infection in different studies may be due to stringent surveillance methods followed and awareness among the health workers about co-infection and common mode of transmission of HBV and HIV. In a study conducted on tribal population with HIV infection visiting sexually transmitted infections clinics the prevalence was found to be 3.4%12 A study on Intra Venous Drug abusers from Chennai revealed a prevalence of HBV as 12%13.  Thus the prevalence of HBV depends on mode of transmission and geographical variation of HIV patients.
The CD4 counts play an important role in ARV therapy initiation in HIV patients with HBV infection.

CONCLUSION: The implications of HBV in HIV patients are of great importance in India too as increasing number of patients are diagnosed to be having HIV disease. The knowledge of HBV infection in a patient of HIV is vital since these patients, as they live longer on antiretroviral treatment will also need to be managed for their infection with HBV its complications like HCC. In addition, the derangement of liver functions as a result of therapy (Antiretroviral therapy or the treatment for opportunistic infections) may also complicate the situation. With initiation of ARV therapy a significant decline in morbidity and mortality from chronic liver disease is expected. Hence improving preventive measures including vaccination and risk reduction, effective screening of HIV patients for HBV or HCV and evaluating the impact of chronic infection on the liver and finally along with early screening of hepatocellular carcinoma is required.

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