Prevalence, associated factors, and viral load dynamics of hepatitis B virus infection among HIV patients in three healthcare facilities of South Kivu province, eastern Democratic Republic of Congo : Chronic hepatitis B virus among HIV patients in South Kivu province.

Abstract

Background: Hepatitis B virus (HBV) significantly impacts public health, particularly among individuals with Human Immunodeficiency Virus (HIV). Co-infection can worsen HBV progression and increase chronic liver disease risks. This study assessed HBV marker frequency, viral load (VL), and associated factors in HIV patients in South Kivu province (Democratic Republic of Congo) to understand the health implications of HBV-HIV co-infection.

Methods: This cross-sectional study, from July 1, 2019, to July 30, 2021, included 864 HIV patients aged 18 to 70 years from General Referral Hospital of Panzi (GRH Panzi), Regional Military Hospital of Bukavu (RMH Bukavu), and Fomulac Hospital. Participants, on antiretroviral therapy, ART (TDF/3TC/DTG or AZT/3TC/LPV/r combinations) or newly diagnosed, consented for blood testing for hepatitis B using enzyme-linked immunosorbent assay (ELISA) and VLs using GeneXpert. Data were analyzed with Stata SE 14.0.

Results: The study found 8.0% HBsAg positivity among HIV patients in South Kivu, with 41.3% and 14.1% showing Anti-HBc and Anti-HBs, respectively. HBsAg positivity was linked to male gender (AOR = 2.96; p = 0.007), rural origin (AOR = 4.32; p = 0.014), treatment at Fomulac Hospital (AOR = 4.87; p = 0.002), marital status (AOR = 4.55; p = 0.036), lower education (AOR = 57.25; p = 0.002), jaundice history (AOR = 3.98; p = 0.021), and < 5 years of unprotected sex (AOR = 10.96; p = 0.002). The HIV VL average was 3.26 ± 3.57 log₁₀ copies/ml, with no significant difference between HIV-only and co-infected individuals (p = 0.6642). In total, 448 (58.0%) participants on ART had undetectable HIV VLs. For HBV, 43.5% had undetectable, 49.3% low, and 7.2% high VLs. A correlation existed between HIV and HBV VLs; undetectable HIV corresponded to undetectable HBV in 62.5%, and high HIV VLs to high HBV in 50.0%.

Conclusion: High HBV co-infection rates in HIV-positive individuals in South Kivu necessitate regular HBV monitoring including prevention, screening, and vaccination strategies in HIV care. Despite ART managing both infections effectively, further research on HBV-related outcomes is essential for improving co-infected patient care.