HIV-positive patients in Kenya have a low rate of coinfection with hepatitis B virus or hepatitis C virus, according to an international study presented to the Fourth International Workshop on HIV and Hepatitis Coinfection in Madrid on June 20th.
But a separate Spanish study presented as a poster to the Workshop has found rates of hepatitis B and hepatitis C coinfection amongst HIV-positive African migrants comparable to those seen in Europeans. Injecting drug use was not a risk factor for hepatitis C infections in these patients, instead the investigators believe these infections originated in medical practice.
There is limited information regarding the prevalence of hepatitis coinfection amongst HIV-positive individuals in Africa. Therefore investigators from Kenya and London’s Chelsea and Westminster Hospital performed blood tests on HIV-positive patients attending the HIV clinic at the Aga Khan University in Nairobi, Kenya, to gain a better understanding of the prevalence of HIV and hepatitis B or hepatitis C coinfection amongst patients of the clinic.
Tests were performed on a total of 378 HIV-positive individuals. A total of 23 (6%) were found to be coinfected with hepatitis B, four patients (1%) were coinfected with hepatitis C, and one patient was infected with HIV and both hepatitis B and hepatitis C.
Statistical analysis revealed that older age was significantly associated with coinfection (p
The investigators concluded that hepatitis coinfection amongst patients in Kenya appeared to be significantly less frequent than that seen in cohorts of HIV-positive patients in Europe and the Americas. But they acknowledged the small size of their study sample and called for further research into this matter to be undertaken in a larger cohort.
Spanish study finds hepatitis B and C coinfection rates comparable in HIV-positive African migrants and HIV-positive Spaniards
But research suggesting that rates of HIV and hepatitis coinfection in sub-Saharan Africa may be comparable to those in southern Europe was also presented to the Workshop.
Investigators in Madrid analysed rates of hepatitis B and hepatitis C coinfection amongst 268 individuals recently diagnosed with HIV at a specialist HIV clinic in the city.
A total of 89 (34%) of these individuals were migrants from sub-Saharan Africa, 52% (20%) were from Latin America, and 122 (46%) were Europeans, mostly Spanish.
Similar proportions of African (5.5%), Latin American (3.8%) and European (4.1%) patients had chronic hepatitis B infection (HBsAG+).
But Africans (65%) were significantly more likely (p
Rates of hepatitis C infection were comparable between Africans (9%) and Europeans (10%), but there were no cases of HIV/hepatitis C coinfection amongst Latin Americans.
The investigators conclude that the rates of chronic hepatitis B are comparable between Europeans and African and Latin American migrants. But African patients were more likely to have isolated core hepatitis B antigen, suggesting “a distant immune response and deeper immune suppression.”
None of the hepatitis C cases observed in Africans were attributed to injecting drug use. Instead, the investigators suggested that “exposure to contaminated blood transfusions, medical equipment or needle-stick injuries in healthcare settings, including traditional healers could be responsible.”
Nelson M. et al. HIV, hepatitis B and hepatitis C coinfection in Kenya. Fourth International Workshop on HIV and Hepatitis Coinfection, Madrid, abstract 71, 2008.
Rivas Gonzalez P. et al. Viral hepatitis in newly diagnosed HIV immigrants in Spain – unexpected HIV rates of HCV antibody and “isolated anti-HBV core” among sub-Saharan Africans. Fourth International Workshop on HIV and Hepatitis Coinfection, Madrid, abstract 61, 2008.