Serological Profile of Hepatitis B Virus Infection HIV Infected Adult Patients in Kano, North Western Nigeria
To determine the serological profile of Hepatitis B virus infection among HIV infected adult patients in Kano. This was a hospital based retrospective observational study where subjects were screened and those who met the inclusion criteria and informed consented were consecutively recruited until required sample size was obtained. Data were collected using the pre-tested interviewer administered questionnaire with sections on socio-demographic information, medical history including risk factors, clinical and laboratory findings. All subjects were thoroughly examined and venous blood samples were taken for necessary investigations and subsequently analysed at the Aminu Kano Teaching Hospital central and PEPFAR laboratories. Data was analysed with SPSS Version 18. Hepatitis B virus has an enormous global impact. Despite the availability of a vaccine, two billion people have been acutely infected. Of these, 240 million remain chronically infected. The infection has different forms of presentation including acute infections, chronic infections, hidden infections, and reactivation when there is immunosuppression. Similarly, there are very sensitive markers such as anti-core, but a positive test can have different meanings. This recently described antigen which is related to the core antigen is an emerging marker that could replace viral DNA. In this review we discuss the laboratory tests necessary for diagnosing the various scenarios of the infection. The hepatitis B virus (HBV) is a health problem throughout the world. It is estimated that 2000 million people have been exposed to the virus and that 240 million are chronically infected making it the most frequent chronic viral infection of all. Between 15% an 40% of those with chronic infections progress to cirrhosis and its complications, including hepatocellular carcinoma. In 2013, HBV Central America was less than 2% and in South America it was 2% to 4%, but in South America there are now 400,000 new cases each year. Despite recommendations for universal vaccination against HBV, this prophylaxis has not been widely implemented in the countries with the highest prevalences due to lack of economic and logistical resources. HBV is a hepatotropic virus with an external envelope and is a member of the Hepadnaviridae family of small deoxyribonucleic acid (DNA) viruses (3,200 base pairs). Its DNA is partially double-stranded and partially single-stranded, and it has a transcriptional template that is covalently closed circular DNA (cDNA) which is introduced very rapidly into the nucleus of the hepatocyte during acute infection. It belongs to the genus Orthohepadnavirus which infects mammals and the genus Avihepadnaviridae which affects birds. It is thought that this virus originated in Africa at least 40,000 years ago. 6 It has 10 genotypes (A-J), A is frequent in North America, Northern Europe and Africa while B and C occur frequently in Asia Some studies have found associations between the genotype, progression of the disease, and response to interferon. Genotypes C and F are more frequently associated with hepatocellular carcinoma as well as some subgenotypes of type A. On the other hand, genotype A is associated with risk of progression to chronic infection. Nevertheless, any acute infection regardless of genotype can progress to a chronic infection. HBV is primarily transmitted through sexual, perinatal, or mucosal routes or through percutaneous parenteral routes resulting from injuries with sharp elements contaminated with infected blood. 8 This last form of transmission includes accidental punctures in hospital environments with contaminated surgical instruments, manicure procedures, pedicures, tattoos, intravenous drug abuse (sharing contaminated syringes) and piercings. Infection from these procedures has decreased as the risks inherent to them have become known, sterilization of medical instruments has been implemented, and reuse of needles has been banned. Sexual transmission has been reduced by education about the use of sexual protection measures. Ninety-five percent of cases of vertical transmission occur during vaginal deliveries and 5% occur through intrauterine transmission.