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ОРИГИНАЛЬРЫЕ ИССЛЕДОВАНИЯ
Эпидемиологический профиль инфекции, вызванной вирусом гепатита В, среди людей, живуших с ВИЧ и СПИДом
Бабазаров И.З.
Азербайджанский медицинский университет, AZ1022, г. Баку, Азербайджанская Республика
Ширванская центральная городская больница, AZ1803, г. Ширван, Азербайджанская Республика
Вирусные гепатиты являются важной причиной заболеваемости и смертности в группе людей, живущих с ВИЧ и СПИДом (ЛЖВС). Эти инфекции могут оказывать взаимное влияние на развитие инфекционного процесса.
Цель исследования - изучение эпидемиологических особенностей и тенденций эпидемического процесса ВГВ-инфекции в различных возрастных, гендерных и региональных группах ЛЖВС с оценкой риска передачи вирусов гепатита в этой группе людей.
Материал и методы. Собраны и проанализированы результаты тестирования 3189 ЛЖВС (01.01.201731.12.21). Диагноз ВИЧ-инфекции верифицировали методом вестерн-блоттинга. НВБАд выявляли с помощью иммуноферментного анализа (ИФА). Возраст участников варьировал в пределах от 1 до 83 лет. Среди них 2124 (бб,б%) мужчины и 1065 (33,4%) женщин. Контрольную группу составили 16 173 безвозмездных донора крови. Для определения уровня статистической значимости различий использовали критерий X2 Пирсона. Различия считали статистически значимыми при р<0,050.
Результаты. Средняя распространенность ВГВ среди ЛЖВС составила 2,948% [95% доверительный интервал (ДИ) 2,648-3,248)], в то время как в контрольной группе она была равна 1,113% (95% ДИ 11951359), т.е. в 2,6 раза выше, чем в контроле (р<0,01). У мужчин как в группе ЛЖВС, так и в контрольной группе частота выявления НВБАд была статистически значимо более высокой, чем у женщин (р<0,01). Серо-преваленность ВГВ и характер распространения не различались по географическим регионам или в разных возрастных группах группы ЛЖВС (р>0,05).
Заключение. Серопревалентность ВГВ среди ЛЖВС составила в среднем 2,948% (95% ДИ 2,648-3,248), тогда как в контрольной группе она была 1,113% (95% ДИ 1,195-1,359), или в 2,6 раза выше (р<0,01).
Финансирование. Исследование не имело спонсорской поддержки. Конфликт интересов. Автор заявляет об отсутствии конфликта интересов.
Для цитирования: Бабазаров И.З. Эпидемиологический профиль инфекции, вызванной вирусом гепатита В, среди людей, живущих с ВИЧ и СПИДом // Инфекционные болезни: новости, мнения, обучение. 2023. Т. 12, № 2. С. 65-68. 001: ИА^/ДЫ. огд/10.33029/2305-3496-2023-12-2-65-68 (англ.) Статья поступила в редакцию 05.01.2023. Принята в печать 28.03.2023.
Ключевые слова:
HBV-инфекция; HBsAg;
эпидемиология; люди, живущие с ВИЧ и СПИДом
Epidemiologic profile of hepatitis B virus infection among people living with HIV and AIDS
Babazarov I.Z. Azerbaijan Medical University, AZ1022, Baku, Republic of Azerbaijan
Shirvan Central City Hospital, AZ1803, Shirvan, Republic of Azerbaijan
Viral hepatitis are an important cause of morbidity and mortality in people living with HIV and AIDS (PLWHA) group. These infections can influence clinical course of each other.
The aim of the current research is to study epidemiological features and tendency of epidemic process of HBV-infection (Hepatitis B virus) in different age, gender and regional PLWHA group. At the same time, an attempt was made to quantify the risk of viral hepatitis transmission in the PLWHA group.
Material and methods. Testing results of 3189 PLWHA were collected and analyzed (01.01.2017-31.12.21). HIV infection diagnosis was confirmed by Western Blot method. HBsAg was detected by the enzyme-linked immunosorbent assay (ELISA). The age of participants was between 1 to 83 years. Among them 2124 (66.6%) were men and 1065 (33.4%) were women. The control group was composed of 16 173 unpaid blood donors. Pearson Chi-Square Test was used to determine the level of statistical significance of differences. Differences were considered statistically significant at p<0.050.
Results. An average seroprevalence of HBV among PLWHA group was 2.948% [95% confidence interval (CI) 2.648-3.248], while in the control group it was equal to 1.113% (95% CI 1.195-1.359), i.e. 2.6 times higher than in the control group (p<0.01). Males in both the PLWHA and control groups in the current investigation had a statistically significantly higher rate of HBsAg detection than had females (p<0.01). The seroprevalence of HBV and distribution patterns did not vary across geographical regions or in different age groups of the PLWHA group (p>0.05).
Conclusion. HBV seroprevalence among the PLWHA was on average 2.948% (95% CI 2.648-3.248), whereas it was 1.113% (95% CI 1.195-1.359) in the control group, i.e. 2.6 times higher (p<0.01).
Keywords:
HBV infection; HBsAg; epidemiology; people living with HIV and AIDS
Funding. The study had no sponsor support.
Conflict of interest. Author declares no conflict of interest.
For citation: Babazarov I.Z. Epidemiologic profile of hepatitis B virus infection among people living with HIV and AIDS. Infektsi-onnye bolezni: novosti, mneniya, obuchenie [Infectious Diseases: News, Opinions, Training]. 2023; 12 (2): 65-8. DOI: https://doi. org/10.33029/2305-3496-2023-12-2-65-68 Received 05.01.2023. Accepted 28.03.2023.
Human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) have several identical epidemiological features. Therefore, they often detected in serum of the patients in different combinations (mixed infections). So, some authors propose to gather them in a group of transfusion transmitted viral infections (TTVI) [1]. Viral hepatitis are an important cause of morbidity and mortality in people living with HIV and AIDS (PLWHA) group. These infections can influence clinical course of each other [2-4]. At the same time other studies did not demonstrate significant impact of viral hepatitis on clinical course of HIV infection [5-7]. Obviously, data on this issue are controversial and additional investigations are needed to resolve it.
Patients with chronic diseases requiring inpatient care for a long time, persons who receive frequent blood transfusions and extracorporeal blood processing procedures as well as injecting drug users and healthcare workers are at high risk for getting TTVI [8]. Moreover, HIV infection is an additional risk factor for viral hepatitis transmission. The rates of coinfection of HIV/HBV or HIV/HCV vary from region to region depending on study population and risk factors for virus transmission [9, 10]. Furthermore, one should not forget that the epidemiological profile of HBV or HCV infection among PLWHA can change from time to time due to viral hepatitis elimination programs of different countries.
The aim of the current research is to study epidemiological features and tendency of epidemic process of HBV-infection in different age, gender and regional the PLWHA group. Besides, an attempt was made to quantify the risk of viral hepatitis transmission in the PLWHA group.
Study design. A retrospective cross-sectional observational study was performed.
Material and methods
Test results of 3189 PLWHA were collected and analyzed. Laboratory tests were performed in Republican AIDS Center. HIV infection diagnosis was confirmed by Western Blot method. Third generation test systems were used to test blood samples for hepatitis B surface antigen (HBsAg) by the enzyme-linked immunosorbent assay (ELISA). Data for period of time from 01.01.2017 to 31.12.21 were collected. Among them 2124 (66.6%) were men and 1065 (33.4%) were women. The age of participants was between 1 to 83 years and they were categorized by age into following groups: 0-5, 5-14, 15-17, 18-25, 26-35, 36-45, 46-55, 56-65 and more than 65 years. The mean age was 37.1 years [95.0% confidence interval (CI) 36.737.5; with standard error of the mean 0.2]. Median age was 36.0 years (The 25th percentile was 29.0 years and the 75th percentile was 44.0 years).
The control group was composed of 16 173 unpaid blood donors (UBD). Among them 13 496 men and 2677 women. The age of participants was between 18 to 65 years. The mean age was 39.0 years (95.0% CI) 38.8-39.1; with standard error of the mean 0.1). Median age was 37.0 years (the 25th percentile was 30.0 years and the 75th percentile was 47.0 years).
Study area. The territory was divided into 3 regions: region 1 - Baku, Sumgait and Absheron; region 2 - Shirvan, Hajikabul, Salyan, Sabirabad and Saatli; region 3 - other territories.
Laboratory measurements. Laboratory tests were performed in Shirvan Regional HIV Laboratory of Republican AIDS Center on the base of Shirvan Central City Hospital. The same third generation test systems with highest levels of sensitivity and specificity to the time of investigation (Bio-Rad, France),
Бабазаров И.З.
ЭПИДЕМИОЛОГИЧЕСКИЙ ПРОФИЛЬ ИНФЕКЦИИ, ВЫЗВАННОЙ ВИРУСОМ ГЕПАТИТА В, СРЕДИ ЛЮДЕЙ, ЖИВУЩИХ С ВИЧ И СПИДОМ
were used to test blood samples of UBD for HBsAg by the ELISA as well as during testing of the PLWHA group at the Republican AIDS Center. Data for period of time from 01.01.2017 to 31.12.21 were collected.
Data analysis. Data analysis was performed by SPSS-26 (IBM, USA). Pearson Chi-Square Tests was used to determine the level of statistical significance of differences. Differences were considered as statistically significant at p<0.050. In addition, asymmetry between groups was taken into account and direct standardization was used to obtain statistically valid results of comparison of these groups. Finally, direct standardization confirmed statistical significance of results.
Results
Male-to-female ratio among the PLWHA group in the current research was 2:1. It could probably be explained by the fact that males usually are characterized by more risky behavior than females.
The seroprevalence of HBV was estimated among the PLWHA group, showing a prevalence which vary from 2.029 to 3.591%, for one calendar year, during the five-year period of study. At the same time, an average prevalence was 2.948% (95% CI 2.648-3.248), while in the control group it was equal to 1.113% (95% CI 1.195-1.359), i.e. 2.6 times higher than in the control group [OR=2.699 (95% CI 2.097-3.473), p<0.001] (see Table).
The seroprevalence of HBV and distribution patterns did not vary across geographical regions in the PLWHA group (p=0.862). Furthermore, statistically significant difference in the prevalence of HBV among different age groups of the PLWHA group was also not revealed (p=0.291).
In the current study, there was a statistically significant increase in HBsAg detection rate among males compared to females and frequency of HBsAg detection among males was equal to 3.625% (95% CI 3.219-4.034) compared to females 1.596% (95% CI 1.212-1.980) in the PLWHA group. In the other words, HBsAg detection rate among males was 2.3 times higher than in females in the PLWHA group (p=0.001).
In our study, there was a significant increase in the rate of mixed infections in the PLWHA group compared to control group (see Figure). Indeed, HIV/HBV/HCV triple infection detection rate among the PLWHA were equal to 0.784% (95% CI 0.628-0.940) while no such cases was revealed in the control group (p<0001). Furthermore, gender features of the mixed infections spread in the study group were also very interesting. Data analysis revealed the predominance of them among males 32.062 (95% CI 31.049-33.075), compared to females 10.329% (95% CI 9.396-11.262) (p<0.001). It could also be explained by the fact that males are characterized by more risky behavior compared to females.
Discussion
The current study has several limitations. Firstly, occult HBV infection was not taken into the consideration in this
HBV seroprevalence among the PLWHA vs. control groups
Indicator Group
control PLWHA P
Ф > Count 15 993 3095
HBs Ag го >сЮ Column N % 98.887 97.052 1
Ф St. error of Column % 0.082 0.300 о о
ф > Count 180 94 0. V
<л Column N % 1.113 2.948
о CL St. error of Column % 0.082 0.300
PLWHA - people living with HIV and AIDS.
study. Consequently, the prevalence of HBV-infected patients might be underestimated. But according to studies the presence of only hepatitis B core antibody (anti-HBcore) in serum with the absence of HBsAg and antibodies to hepatitis B surface antigen (anti-HBs) is noted in 0.4-1.7% of blood donors in places with a low prevalence of hepatitis B [11, 12] and in 10-20% of the population of endemic countries [13, 14]. Thus, it has little effect on the study results.
Secondly, patients could be infected with HBV but then they might be cured before the investigation was started or before they became HIV infected. But probably this limitation has a little impact to results of investigation.
Thirdly, data missing was. But it was insignificant.
Finally, all these limitations did not affect the estimates.
Conclusion
The findings of this study can be understood as:
1) an average seroprevalence of HBV among the PLWHA group was 2.948% (95% CI 2.648-3.248)), while in the control group it was equal to 1.113% (95% CI 1.195-1.359), i.e. 2.6 times higher than in the control group [OR=2.699 (95% CI 2.097-3.473), p<0.001];
2) the seroprevalence of HBV and distribution patterns did not vary across geographical regions or in different age groups in the PLWHA group (p=0,862);
3) significant increase in the rate of mixed infections among the PLWHA group compared to control group was revealed (p<0.001);
4) males of the PLWHA group in the current investigation had a statistically higher rate of HBsAg detection than had females (p<0.001).
Acknowledgment. The author is grateful for his help in statistical data processing to Ismail Gafarov, PhD.
1.662
0.784
0.282
HBV + HIV
HBV+HCV+ HIV
HBV + Lues + HIV
0.220
HBV+HCV+ Lues + HIV
Prevalence of coinfections containing HBV among PLWHA
СВЕДЕНИЯ ОБ АВТОРЕ
Бабазаров Илькин Зафар оглы (Ilkin Z. Babazarov) - докторант кафедры эпидемиологии Азербайджанского медицинского университета, Баку, Республика Азербайджан; врач-инфекционист Ширванской центральной городской больницы, Ширван, Республика Азербайджан E-mail: babazarov@gmaiL.com https://orcid.org/0000-0002-2012-8701
ABOUT THE AUTHOR
Ilkin Z. Babazarov - Department of Epidemiology Azerbaijan Medical University, Baku, Republic of Azerbaijan; Shirvan Central City Hospital, Shirvan, Republic of Azerbaijan E-mail: babazarov@gmail.com https://orcid.org/0000-0002-2012-8701
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7. Rockstroh J.K., Mocroft A., Soriano V., Tural C., Losso M.H., Horban A. et al. Influence of hepatitis C virus infection on HIV-1 disease progression and response to highly active antiretroviral therapy // J. Infect. Dis. 2005. Vol. 192, N 6. P. 992-1002. DOI: https://doi.org/10.1086/432762; PMID: 16107951.
8. Бабазаров И.З. О значении сведений об эпидемиологических и вирусологических особенностях инфекций, вызванных вирусами гепатитов В и С у медицинских работников в Азербайджане // Современные достижения азербайджанской медицины. 2021. № 2. С. 3-6.
9. Koziel M.J., Peters M.G. Viral hepatitis in HIV infection // N. Engl. J. Med. 2007. Vol. 356, N 14. P. 1445-1454. DOI: https://doi.org/10.1056/NEJMra065142; PMID: 17409326.
10. Chen J.J., Yu C.B., Du W.B., Li L.J. Prevalence of hepatitis B and C in HIV-infected patients: A meta-analysis // Hepatobiliary Pancreat. Dis. Int. 2011. Vol. 10, N 2. P. 122-127. DOI: https://doi.org/10.1016/s1499-3872(11)60020-9; PMID: 21459717.
11. Hadler S.C., Murphy B.L., Schable C.A., Heyward W.L., Francis D.P., Kane M.A. Epidemiological analysis of the significance of low-positive test results for antibody to hepatitis B surface and core antigens // J. Clin. Microbiol. 1984. Vol. 19, N 4. P. 521525. DOI: https://doi.org/10.1128/jcm.19.4.521-525.1984; PMID: 6715519.
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10. Chen J.J., Yu C.B., Du W.B., Li L.J. Prevalence of hepatitis B and C in HIV-in-fected patients: A meta-analysis. Hepatobiliary Pancreat Dis Int. 2011; 10 (2): 122-7. DOI: https://doi.org/10.1016/s1499-3872(11)60020-9; PMID: 21459717.
11. Hadler S.C., Murphy B.L., Schable C.A., Heyward W.L., Francis D.P., Kane M.A. Epidemiological analysis of the significance of low-positive test results for antibody to hepatitis B surface and core antigens. J Clin Microbiol. 1984; 19 (4): 521-5. DOI: https://doi.org/10.1128/jcm.19.4.521-525.1984; PMID: 6715519.
12. Joller-Jemelka H.I., Wicki A.N., Grob P.J. Detection of HBs antigen in «anti-HBc alone» positive sera. J Hepatol. 1994; 21 (2): 269-72. DOI: https://doi.org/10.1016/ s0168-8278(05)80407-6; PMID: 7989721.
13. Lok A.S., Lai C.L., Wu P.C. Prevalence of isolated antibody to hepatitis B core antigen in an area endemic for hepatitis B virus infection: Implications in hepatitis B vaccination programs. Hepatology. 1988; 8 (4): 766-70. DOI: https://doi. org/10.1002/hep.1840080411; PMID: 2968945.
14. Feret E., Larouze B., Diop B., Sow M., London W.T., Blumberg B.S. Epidemiology of hepatitis B virus infection in the rural community of Tip, Senegal. Am J Epidemiol. 1987; 125 (1): 140-9. DOI: https://doi.org/10.1093/oxfordjournals.aje. a114497; PMID: 3788943.
