Blood-borne viral co-infections among HIV+ inmates

Via:  http://goo.gl/mbSFE5

Chronic Hepatitis B Increases Mortality & Complexity among HIV-Coinfected Patients in South Africa

OBJECTIVES:

To assess the effect of chronic hepatitis B on survival and clinical complexity among people living with HIV following antiretroviral therapy (ART) initiation.

METHODS:

We evaluated mortality and single-drug substitutions up to 3 years from ART initiation (median follow-up 2.75 years; interquartile range 2-3 years) among patients with and without chronic hepatitis B (CHB) enrolled in a workplace HIV care programme in South Africa.

RESULTS:

Mortality was increased for CHB patients with hepatitis B virus (HBV) DNA levels > 10 000 copies/mL (adjusted hazard ratio 3.1; 95% confidence interval 1.2-8.0) compared with non-CHB patients. We did not observe a similar difference between non-CHB patients and those with CHB and HBV DNA < 10 000 copies/mL (adjusted hazard ratio 0.70; 95% confidence interval 0.2-2.3). Single-drug substitutions occurred more frequently among coinfected patients regardless of HBV DNA level.

CONCLUSIONS:

Our findings suggest that CHB may increase mortality and complicate ART management.

Purchase full article at:   http://goo.gl/PvnJ70

By:  Velen K1, Charalambous S1,2, Innes C1, Churchyard GJ1,2, Hoffmann CJ1,3,2.

• 1The Aurum Institute, Johannesburg, South Africa.
• 2School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
• 3Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA. 
• HIV Med. 2016 Mar 17. doi: 10.1111/hiv.12367.

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Sero-Prevalence of HBV & Associated Risk Factors among HIV Positive Individuals Attending ART Clinic at Mekelle Hospital, Tigray, Northern Ethiopia

BACKGROUND:

Because of the shared mean of transmission, hepatitis B virus (HBV) is one of an important cause of co-morbidity and mortality in peoples living with HIV/AIDS. Hence, the aim of this study was to determine the sero-prevalence of HBV infection and associated risk factors in HIV/AIDS positive individuals attending ART clinic at Mekelle hospital, Mekelle, Northern Ethiopia.

METHODS:

A cross sectional study was conducted from August to October 2014 in HIV/AIDS positive adult individuals. Socio-demographic data and other explanatory variables were collected from 508 study participants using pre-tested and structured questionnaire-based interviews. Serum hepatitis B surface antigen (HBsAg) was detected using commercially available rapid test and third generation enzyme-linked immunosorbent assay (ELISA). Bivariate and multivariate analysis, using SPSS V.20.0, were performed to assess the variables associated with HBV infection and P value less than 0.05 was considered as statistically significant.

RESULTS:

A total of 508 study participants, 305 females and 203 males were included in this study with the mean (+SD) age of 37.8 + 9.6. The sero-prevalence of HBsAg was 5.9 %. Male gender (AOR = 2.6, 95 % CI 1.2-5.7), multiple sexual partners (AOR = 4.2, 95 % CI 1.3-13.1) and CD4 count <200 cells/μl (AOR = 3.5, 95 % CI 1.1-11.2) were significantly associated with HBsAg positivity.

CONCLUSION:

The prevalence of HBsAg was similar to the general population. However, HIV/AIDS positive individuals with reduced CD4 count, <200 cells/μl, showed a significant association with HBsAg seropositivity. Therefore, we recommended, all HIV/AIDS positive individuals should be screened for HBsAg during their follow for better treatment outcome and minimize risks of HBV transmission.

Bivariate analysis of associated risk factors for HBV infection in Mekelle among HIV positive individuals

Variables	HBV sero status
	Total = 508	Yes = 30	No = 478	COR (95 % CI)	P value
	Total n (%)	+ve N (%)	−ve N (%)
Blood transfusion
No	467 (91.9)	27 (5.8)	440 (94.2)	1
Yes	41 (8.1)	3 (7.3)	38 (92.7)	1.3 (0.4–4.4)	0.690
Unsafe injection
No	475 (83.5)	26 (5.5)	449 (94.5)	1
Yes	33 (6.5)	4 (12.1)	29 (87.9)	2.4 (0.8–7.3)	0.128*
Multiple sexual partners
No	482 (94.9)	25 (5.2)	457 (94.8)	1
Yes	26 (5.1)	5 (19.2)	21 (80.8)	4.4 (1.5–12.5)	0.006*
Surgical history
No	408 (80.3)	20 (4.9)	388 (95.1)	1
Yes	100 (19.7)	10 (10)	90 (90)	2.2 (1.0–4.8)	0.058*
Tooth extraction
No	319 (62.8)	20 (6.3)	299 (93.7)	1
Yes	189 (37.2)	10 (5.3)	179 (94.7)	0.8 (0.4–1.8)	0.651
Abortion
No	475 (93.5)	29 (6.1)	446 (93.9)	1
Yes	33 (6.5)	1 (3)	32 (97.0)	0.5 (0.1–3.6)	0.478
Tattooing
No	447 (88)	27 (6)	420 (94)	1
Yes	61 (12)	3 (4.9)	58 (95.1)	0.8 (0.2–2.7)	0.728
Family having liver disease
No	468 (92)	28 (6)	440 (94)	1
Yes	40 (7.9)	2 (5)	38 (95)	0.8 (0.2–3.6)	0.800
CD4 count
<200 cells/μl	85 (16.5)	9 (10.6)	76 (89.4.)	3.9 (1.3–12.1)	0.018*
200–350 cells/μl	118 (23.2)	7 (5.9)	111 (94.1)	2.1 (0.6–6.7)	0.221
351–499 cells/μl	135 (26.6)	9 (6.7)	126 (93.3)	2.4 (0.8–7.2)	0.133*
≧500 cells/μl	170 (33.5)	5 (2.9)	165 (97.1)	1
ART status
Pre ART	65 (12.8)	2 (3.1)	63 (96.9)	1
ART	443 (87.2)	28 (6.3)	415 (93.7)	2.1 (0.5–9.1)	0.311
ART drugs
AZT,3T, Nuv	106 (24.5)	7 (6.6)	99 (93.4)	1.2 (0.5–3.4)	0.678
AZT,3T, Evf	58 (13.4)	6 (10.3)	52 (89.7)	2.0 (0.7–6.0)	0.200
TDF,3T, Nuv	101 (23.4)	6 (5.9)	95 (94.1)	1.1 (0.4–3.2)	0.849
TDF,3T, EFV	167 (38.7)	9 (5.4)	158 (94.6)	1

COR crude odds ratio

* Statistically significant at P < 0.2

Full article at:   http://goo.gl/fVPpuR

By:  Weldemhret L1, Asmelash T2, Belodu R2, Gebreegziabiher D2.

• 1Medical Microbiology Laboratory, Mekelle Hospital, Mekelle, Ethiopia.
• 2Department of Medical Microbiology and Immunology, College of Health Sciences, Mekelle University, Mekelle, Ethiopia.
• AIDS Res Ther. 2016 Feb 4;13:6. doi: 10.1186/s12981-016-0090-2. eCollection 2016. 

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Asian-Pacific Clinical Practice Guidelines on the Management of Hepatitis B: A 2015 Update

Worldwide, some 240 million people have chronic hepatitis B virus (HBV), with the highest rates of infection in Africa and Asia. Our understanding of the natural history of HBV infection and the potential for therapy of the resultant disease is continuously improving. New data have become available since the previous APASL guidelines for management of HBV infection were published in 2012. 

The objective of this manuscript is to update the recommendations for the optimal management of chronic HBV infection. The 2015 guidelines were developed by a panel of Asian experts chosen by the APASL. The clinical practice guidelines are based on evidence from existing publications or, if evidence was unavailable, on the experts’ personal experience and opinion after deliberations. Manuscripts and abstracts of important meetings published through January 2015 have been evaluated. 

This guideline covers the full spectrum of care of patients infected with hepatitis B, including new terminology, natural history, screening, vaccination, counseling, diagnosis, assessment of the stage of liver disease, the indications, timing, choice and duration of single or combination of antiviral drugs, screening for HCC, management in special situations like childhood, pregnancy, coinfections, renal impairment and pre- and post-liver transplant, and policy guidelines. 

However, areas of uncertainty still exist, and clinicians, patients, and public health authorities must therefore continue to make choices on the basis of the evolving evidence. The final clinical practice guidelines and recommendations are presented here, along with the relevant background information.

Below:  Treatment indications for chronic HBV-infected patients with cirrhosis or reactivation of chronic HBV infection

Below:  Treatment indications for noncirrhotic HBeAg-positive chronic HBV-infected patients

Below:  Treatment indications for noncirrhotic HBeAg-negative chronic HBV-infected patients

Below:  Reverse transcriptase mutations associated with drug resistance

Below:  Cumulative incidence of antiviral resistance in long-term studies of NA therapy

Below:  Treatment of CHB infection in HIV infected individuals

Below:  Treatment of HBV–HCV coinfected patients

Recommendations for infected persons regarding prevention of transmission of HBV to others

Have sexual contacts vaccinated

Use barrier protection during sexual intercourse if partner not vaccinated or naturally immune

Do not share toothbrushes or razors

Cover open cuts and scratches

Clean blood spills with detergent or bleach

Do not donate blood, organs or sperm

Can participate in all activities including contact sports

Children should not be excluded from daycare or school participation and should not be isolated from other children

Can share food, utensils, or kiss others

Full article at:  http://goo.gl/1208wm

By:  S. K. Sarin, M. Kumar, G. K. Lau, Z. Abbas, H. L. Y. Chan, C. J. Chen, D. S. Chen, H. L. Chen, P. J. Chen, R. N. Chien, A. K. Dokmeci, Ed Gane, J. L. Hou, W. Jafri, J. Jia, J. H. Kim, C. L. Lai, H. C. Lee, S. G. Lim, C. J. Liu, S. Locarnini, M. Al Mahtab, R. Mohamed, M. Omata, J. Park, T. Piratvisuth, B. C. Sharma, J. Sollano, F. S. Wang, L. Wei, M. F. Yuen, S. S. Zheng, and J. H. Kao

Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India

Division of Gastroenterology and Hepatology, Humanity and Health Medical Centre, Hong Kong SAR, China

Department of Hepatogastroenterlogy, Sindh Institute of Urology and Transplantation, Karachi, Pakistan

Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China

Genomics Research Center, Academia Sinica, National Taiwan University, Taipei, Taiwan

Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan

Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan

Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan

Liver Research Unit, Chang Gung Memorial Hospital and University, Chilung, Taiwan

Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey

New Zealand Liver Transplant Unit, Auckland City Hospital, Auckland, New Zealand

Department of Infectious Diseases and Hepatology Unit, Nanfang Hospital, Guangzhou, China

Department of Medicine, Aga Khan University, Karachi, Pakistan

Beijing Friendship Hospital, Capital Medical University, Beijing, China

Seoul, Korea

Department of Medicine, University of Hong Kong, Hong Kong, China

Internal Medicine Asan Medical Center, Seoul, Korea

Division of Gastroenterology and Hepatology, National University Health System, Singapore, Singapore

Research and Molecular Development, Victorian Infectious Diseases Reference Laboratory, Melbourne, Australia

Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh

Department of Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia

Yamanashi Hospitals (Central and Kita) Organization, 1-1-1 Fujimi, Kofu-shi, Yamanashi 400-8506 Japan

Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea

NKC Institute of Gastroenterology and Hepatology, Prince of Songkla University, Songkhla, Thailand

Department of Gastroenterology, G.B. Pant Hospital, New Delhi, India

Department of Medicine, University of Santo Tomas, Manila, Philippines

The Institute of Translational Hepatology, Beijing, China

Treatment and Research Center for Infectious Diseases, Beijing 302 Hospital, Beijing, China

Peking University Hepatology Institute, Beijing, China

Division of Gastroenterology and Hepatology, Department of Medicine, University of Hong Kong, Pofulam, Hong Kong

Department of Hepatobiliary and Pancreatic Surgery, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003 Zhejiang Province China

Graduate Institute of Clinical Medicine and Hepatitis Research Center, National Taiwan University College of Medicine, National Taiwan University Hospital, Taipei, Taiwan

S. K. Sarin, Email: moc.liamg@nirasvihs.

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Proportion & Factors Associated with Hepatitis B Viremia in ART Naïve & Experienced HIV Co-Infected Ghanaian Patients

Background

The global burden of Hepatitis B virus (HBV) and HIV co-infection is enormous. The risk of developing cirrhosis and hepatocellular cancer is associated with HBV DNA levels. The main objective of the study was to determine proportion of Hepatitis B viremia in ART-naïve and ART-experienced co-infected Ghanaian patients and factors associated with HBV viremia after at least 36 weeks of lamivudine with or without tenofovir containing ART.

Methods

Hepatitis B and HIV co-infected patients who were ART-naïve or had received at least 9 months of lamivudine-containing ART were enrolled in a cross-sectional study at Korle-Bu Teaching Hospital. Demographic and clinical data were collected and samples obtained for Hepatitis B serology, liver function tests and HBV DNA. Factors associated with viremia were determined using univariate and multivariate logistic regression analysis.

Results

Of 3108 HIV-infected patients screened, 257 (8.3 %) were HBsAg-positive, of which 235 enrolled. Overall, 152 (64.7 %) were ART-experienced and 83 (35.3 %) were ART-naïve. Eighty-nine-percent of ART-naïve and 42.1 % of ART-experienced patients had HBV DNA > 20 IU/mL. In multivariate analysis of all patients, being ART-naïve (OR 10.1, 95 % CI 4.6 – 21.9) and elevated ALT (OR 3.7, 95 % CI 1.8 – 7.9) were associated with Hepatitis B viremia. In treatment experienced patients, elevated ALT (OR 4.8 CI 2.0 – 12.1) and male sex (OR 2.1, 95 % CI 1.0 – 4.2) were associated with Hepatitis B viremia.

Conclusions

Majority of ART-naïve (89 %) and 42 % of ART-experienced patients had detectable hepatitis B viremia > 20 IU/mL. An abnormal serum ALT was significantly associated with hepatitis B viremia in HBV and HIV co-infected patients irrespective of treatment status. Baseline and on-treatment ALT may be a useful non-invasive predictor of Hepatitis B viremia in resource-constrained countries in sub-Saharan Africa where infection is endemic and viral load tests are not widely available.

Full article at:   http://goo.gl/cTjFtw

By:  Timothy N. A. Archampong, Margaret Lartey, Kwamena W. Sagoe, Adjoa Obo-Akwa, Ernest Kenu, Fizza S. Gillani,Hongmei Yang, Isaac Boamah, Timothy Flanigan, and Awewura Kwara

Department of Medicine and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana

Korle-Bu Teaching Hospital, Accra, Ghana

Department of Microbiology, School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, Accra, Ghana

Warren Alpert Medical School of Brown University, Providence, RI USA

The Miriam Hospital, Providence, RI USA

Department of Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry, Rochester, NY USA

Timothy N. A. Archampong, Phone: 00233-203039841, Email: ku.ten.srotcod@aant.

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