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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Prevalence of infection with hepatitis B and C virus and coinfection with HIV in medical inpatients in Malawi
Journal of Infection, Volume 57, No. 1, Year 2008
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Description
Background: Coinfection with hepatitis B (HBV) or hepatitis C (HCV) adversely affects the prognosis of HIV infection and vice versa, and results in complex interactions with antiretroviral therapy. These infections are common in sub-Saharan Africa but there are few data on prevalence of coinfection. All three components of the most common ART regimen used in Africa, stavudine, lamivudine and nevirapine, can cause hepatic problems and lamivudine resistant HBV is known to emerge after HBV monotherapy in coinfected patients. Point of care (POC) tests for HBV and HCV are widely used but have not been validated in field tests in sub-Saharan Africa. Methods: Prospective observational study of sequential adult inpatients in medical wards of a large urban teaching hospital in Malawi in 2004. Comparison of demographic risk factors with HIV antibody status determined using local double POC test protocols, and with HBsAg and HCV antibody prevalence as estimated in a reference laboratory in Liverpool, UK. Results of locally performed POC tests for HBV using Determine HBsAg (Abbott) and for HCV antibody using HCV-SPOT (Genelabs) were compared with results of reference methods in the UK. Results: Of 226 adults (39% male), median (range) age 35 (14-80) years, 81% had a history of traditional scarification, 12% a history of blood transfusion and 11% a history of jaundice. HIV antibodies were present in 76.1%, HBsAg in 17.5% and HCV in 4.5%, with HIV/HBV coinfection in 20.4% and HIV/HCV coinfection in 5% of those with HIV. There was no correlation between prevalence of any of the three viruses and demographic risk factors or presence of either of the other two viruses. Point of care tests gave misleading results with prevalence estimates of 38% for HBV and 4.5% for HCV. For both of these POC tests the performance indices were unacceptable for individual patient management or epidemiological survey purposes. Conclusions: The high prevalence of hepatitis/HIV coinfections may impact on treatment with antiretroviral therapy, especially if there are unintended interruptions of therapy, and studies are needed to document the possible clinical impact on ART programmes. The poor performance of POC tests for HBV and HCV may be due to local operational problems or to unexpected technical issues not revealed by early validation tests. These tests are widely used in resource poor settings and should be revalidated in prospective field studies in areas of the tropics with high HIV prevalence rates. © 2008 The British Infection Society.
Authors & Co-Authors
Nyirenda, Moffat J.
Malawi, Zomba
University of Malawi
Beadsworth, Michael B.J.
Malawi, Zomba
University of Malawi
United Kingdom, Liverpool
Royal Liverpool University Hospital
Stephany, P.
Malawi, Zomba
University of Malawi
Hart, Charles Anthony
Unknown Affiliation
Hart, Ian J.
United Kingdom, Liverpool
Royal Liverpool University Hospital
Munthali, C.
Malawi, Zomba
University of Malawi
Beeching, Nicholas J.
United Kingdom, Liverpool
Royal Liverpool University Hospital
United Kingdom, Liverpool
Liverpool School of Tropical Medicine
Zijlstra, Eduard Evert
Malawi, Zomba
University of Malawi
Statistics
Citations: 128
Authors: 8
Affiliations: 3
Identifiers
Doi:
10.1016/j.jinf.2008.05.004
ISSN:
01634453
Research Areas
Health System And Policy
Infectious Diseases
Study Design
Cross Sectional Study
Cohort Study
Study Approach
Quantitative
Study Locations
Malawi
Participants Gender
Male