Incidence of hepatitis B virus infection among human immunodeficiency virus-infected treatment naïve adults in Botswana

Bonolo Bonita Phinius, Motswedi Anderson, Resego Bokete, Tshepiso Mbangiwa, Wonderful Tatenda Choga, Kabo Baruti, Joseph Makhema, Rosemary Musonda, Jason T. Blackard, Max Essex, Sikhulile Moyo, Richard Marlink, Simani Gaseitsiwe

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1 Scopus citations


Hepatitis B virus (HBV) and human immunodeficiency virus (HIV) coinfection is highest in sub-Saharan Africa and results in accelerated clinical outcomes compared with HBV or HIV mono-infection. HBV clearance rates are higher in healthy adults; however, in sub-Saharan Africa, there are limited data on clearance of incident HBV in HIV-infected adults. Therefore, we sought to estimate HBV incidence and HBV surface antigen (HBsAg) clearance in HIV-infected adults in Botswana.This was a retrospective longitudinal study of 442 HIV-1C infected treatment naïve patients enrolled in a previous Botswana Harvard AIDS Institute Partnership study. Archived plasma samples from 435 HIV-infected treatment naïve participants were screened for HBsAg and HBV core antibody (anti-HBc). HBsAg was evaluated annually over a 4-year period, and HBV deoxyribonucleic acid (DNA) levels of HBsAg-positive chronic and incident patients were quantified.Baseline median CD4+ T-cell count was 458cells/μL [Q1, Q3: 373, 593], and median HIV viral load was 4.15copies/mL [Q1, Q3: 3.46, 4.64]. Twenty two HBV incident cases occurred, representing an incidence of 3.6/100 person-years [95% CI: 2.2-5.6]. All incident HBV cases with a follow-up sample available for screening (13/22) cleared HBsAg. Detectable HBV viral loads among chronic and incident cases ranged between 5.15×101 to 1.4×107IU/L and 1.80×101 to 1.7×108IU/mL, respectively.We report high HBV incidence associated with elevated HBV DNA levels despite high CD4+ T-cell counts in HIV-infected patients in Botswana. These incidence cases represent a potential source of HBV transmission in the population. Scaling-up of HIV treatment strategies utilizing antiretroviral therapy regimens with anti-HBV activity coupled with screening for HBV infections in households of the HBsAg-positive cases is recommended.

Original languageEnglish (US)
Article numbere19341
JournalMedicine (United States)
Issue number9
StatePublished - 2020

All Science Journal Classification (ASJC) codes

  • Medicine(all)


  • Botswana
  • Sub-Saharan Africa
  • hepatitis B virus
  • hepatitis B virus incidence
  • human immunodeficiency virus


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