A Tale of Two Viruses: Seroepidemiological and a Cross-Sectional Insights into HIV/HBV Coinfection in Selected Hospitals in Rivers State, Nigeria

ABSTRACT


INTRODUCTION
One of the frequent complications in HIV-infected patients is dual infection with HBV and coinfection with hepatitis B is common among HIV-infected individuals (Okonko et al., 2022).Hepatitis B and HIV infections are significant public health problems in sub-Saharan Africa, and research suggests that co-infected individuals with either HBV or HIV experience a higher rate of HIV progression (
HBV infection is a significant global public health issue (Cookey et al., 2022;Okonko et al., 2023a).Globally, it is estimated that 5%-10% of people living with HIV are coinfected with hepatitis B virus (HBV), while HIV/HBV frequency in sub-Saharan Africa varied from 0.0% to 28.4% Nigeria has one of the highest chronic viral hepatitis disease burdens in the world (Cookey et al., 2022;Okonko et al., 2023a).The prevalence of HIV/HBV co-infection in Nigeria is reported to range between 10% and 70 % (Omatola et al., 2019; Ugwu et al., 2023b).As of 2013, an estimated 13.6% of the Nigerian population had been reported to be chronic carriers of HBsAg (Musa et al., 2015;Akindigh et al., 2019).Consequently, the burden of disease is considered to be high, as evidenced by the high incidence of morbidity and mortality associated with the virus (Lok, 2005;Akindigh et al., 2019).
Co-infection with HIV and HBV viruses causes complex interactions (Ihongbe et al., 2022).Coinfection of HBV with HIV is associated with significant morbidity and mortality globally (Okonko et al., 2023b).HBV infection poses hazards to antiretroviral therapy (ART)-related liver damage, limits CD4 recovery, accelerates immunologic progression, and increases morbidity and mortality in HIVinfected patients (Wandeler et al., 2013; Ihongbe et al., 2022).Although co-infection with HBV has been linked to higher HIV RNA turnover, increased liver morbidity, and complex HIV pathology, it is not typically considered in the therapy of HIV infection (Wandeler et al., 2013; Ihongbe et al., 2022).Thus, this study aimed at unveiling the seroepidemiological patterns of HBV coinfections among HIV-infected individuals in some selected hospitals in Rivers State, Nigeria.

Study Area
The study was carried out in selected areas of Rivers State in Nigeria, in an urban setting with a population of 7,034,973.

Study population
The study population included male and female individuals living with HIV that attend ART clinics at the Rivers State University Teaching Hospital, Military Hospital and Modern Primary Health Care Center, Rumuji.Three hundred and fifty (350) HIV-infected individuals were selected and participated in the study.Individuals included in the study were males and females confirmed and documented as being positive for HIV infection that are on ART.While individuals who decline and HIV negatives were not included in the study.A random sampling irrespective of age, gender and ethnicity was done to ensure that sampling was representative of Rivers State, Nigeria.Sociodemographic data such as age, sex, marital status, education and occupation and clinical data for every participant were obtained using a questionnaire.

Sample Collection and Preparation
Blood samples (about 5ml) were aseptically collected from the participants during routine investigations, after obtaining written informed consent from the participants.The samples were collected into sterile EDTA bottles and plasma samples were obtained after centrifugation.Samples were appropriately labelled and stored in two aliquots at -20°C and -80 O C until analysis.

Serological Analysis of Hepatitis B Surface Antigen (HBsAg)
Serum samples were analyzed for HBsAg using the ELISA kit (DIA.PRO Diagnostic Bioprobes, Italy).The tests were performed according to the manufacturer's instructions.

Data analysis
Data were systematically analyzed as appropriate.The chi-Square test was done using SPSS (Statistical Package for Social Sciences) software.
(Okonko et al., 2015), the 6.3% in Uyo, Akwa Ibom State, Nigeria (Innocent-Adiele et al., 2021), the 6.1% in Tanzania (Nyalika, 2021), the 6.0% in the northern Nigerian communities(Adesegun etal., 2020), the 5.5% in Keffi, Central Nigeria (Oti et al., 2021), the 4.83% in Douala, Cameroon (Cyrille et al., 2019), the 4.0% in Banik et al.( (Nnakenyi et al., 2020)konko et al., 2023a, b, Ugwu et al., 2023a) where a higher prevalence was reported among females than males.However, this observation also contradicted the work byBhattarai et al. (2018)andUgwu et  al. (2023b), where the co-infection was higher in males.This finding may not correspond with the proposition that coinfection deteriorates the immune status leading to poorer outcomes(Nnakenyi et al., 2020).This study may also observe a reverse from the claims that individuals with a CD4 cell count of less than 200 cells/mm 3 have a 16.2 times higher risk of liver-related deaths than those with a CD4 count of greater than 350cells/mm3(Falade-Nwulia et al., 2012; Boateng et al., 2019; Nnakenyi et al., 2020).Furthermore, the viral loads of the HIV/HBV coinfected participants did not follow any definite patterns.A higher co-infection rate occurred among coinfected patients with targets not detected (5.4%) which was followed by those with 40-1000 copies/ml (1.4%).This finding is comparable to that of other studies(Okonko etal., 2023b; Ugwu et al., 2023a).However, this assertion is at variance with some studies in Nigeria (Okonko et al., 2020; Innocent-Adiele et al., 2021; Precious et al., 2022; Okonko & Shaibu, 2023; Ugwu et al., 2023b).CONCLUSION This study observed an HIV/HBV coinfection rate of 2.6% which has further confirmed the persistence of HIV/HBV co-infection in Rivers State, Nigeria.Ongoing and persistent public health interventions among the study population are thereby advocated.