Immunovirological and Biochemical Changes in Nigerian Patients with Hepatitis B Coinfection on Antiretroviral Therapy 35
patients were on combivir and nevirapine, while the coin-
fected patients were mainly on truvada and nevirapine.
4. Discussion
This study has further shown a high HBV coinfection
rate among our patient cohorts as previously noted by us
and other authors in Africa [6,11,12] but higher than
values obtained in the Western world with lower inci-
dence of HBV [13,14]. The preponderance of the female
gender had been suggested to be due to the fact that
women may be more sensitive to changes in their health
and probably socioculturally conditioned to seek health
care more than men [6]. The significantly higher coinfec-
tion among men compared with women in spite of a
predominant female gender affected with HIV is likely a
reflection of HBV prevalence among the general popula-
tion which has been noted to be higher amongst men [15].
The lower prevalence of coinfection among the better
educated individuals generally could be due to the level
of awareness that may be associated with education and
therefore behaviours and practices that may reduce HBV
transmission [16]. It is however surprising that no dif-
ference in HBV prevalence was found across the differ-
ent marital status. It would have been expected, arguably
though, that divorcees and the unmarried would be more
exposed to transmission of HBV sexually. This phe-
nomenon might be confirming the well known fact that
HBV transmission is mainly horizontal in childhood
among Africans. Ola et al. however found out that HIV
monoinfection is commoner among married people
(70.4%), suggesting heterosexual transmission of HIV in
our environment as previously documented [16]. It
would appear that the immunological status of HBV
coinfection and monoinfection is similar, as evidenced
by the similar CD4 counts in HIV monoinfected and
HIV-coinfected at the start of CART. Similar observa-
tions were made Idoko et al. in the Northern part of Ni-
geria [17]. It is evident from our study that CART has no
influence on CD4 recovery regardless of HBV status
with time and duration of therapy. Idoko et al. however
found an association with Hepatitis B e antigen (HBeAg)
and CD4 T-cell recovery and HIV-RNA clearance [17].
Apart from the higher baseline values of transaminases
among HBV coinfected patients, no temporal difference
was observed in the normalization of ALT, urea and
creatinine among coinfected and monoinfected patients,
suggesting that HBV status did not significantly influ-
ence the immunovirological response to CART, renal
function and transaminase levels. The retrospective na-
ture of this study and our inability to determine the date
of acquisition of both HIV and HBV (acute or chronic),
as well as unavailability of HBV DNA are some of the
limitations of our study. The exclusion of subjects with
missen data may also affect the result as it is unclear
whether such cases were missing for reasons connected
with the study outcome.
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