Background:  The exact prevalence of hepatitis B virus (HBV) in the HIV population in South Africa is not known. HBV and hepatitis C virus (HCV) serology is not standard of care and done only if liver function tests are elevated. This is one of the first prospective observational studies of the prevalence of HBV and HCV in HIV-seropositive patients in a South African clinic.   

Methods:  We screened 320 patients for HBV and 98 patients for HCV using standard serology. HBV and HCV viral loads were not assayed. The patients were recruited from an ART clinic in a tertiary government teaching hospital in Johannesburg.  No previous hepatitis serology had been done. The patients were naïve to ART.   

Results:  We tested 231 females and 89 males for HBV, and 74 females and 22 males for HCV. All patients were of either African or mixed African race. The average age of the patients was 37.2±8.7 years. Of the 320 HBV serology results:  18 (5.6%) were hepatitis surface antigen (HbsAg)⁺, 34 (10.6%) were hepatitis core antibody (HBcAb)⁺; 75 (23%) were HBsAb⁺HBcAb^– ; 8 (2.5%) were HBsAb⁺; and 185 (57.8%) were hepatitis serology negative. Almost 42% of the population showed some evidence of exposure to HBV, and 5.6% had active hepatitis. Of the 18 patients who were positive for HBsAg, 6 had normal serum aminotransferases, 6 had minimal grade 1, and 3 had grade 2 elevations serum transferases; 1 result is pending. HCV was rare:  of 98 patients, only 1 (1.0%) had positive hepatitis C antibody and normal serum aminotransferases.

Conclusions:  Very little is known about the effect these viral hepatitides will have on our HIV patients, especially using the stavudine (d4T)/lamivudine (3TC) backbone in first-line therapy. This is currently under study. Thus far only 42% of our patients have been exposed to HBV, indicating that a vaccine program for adults might be helpful. As seen in this cohort, two-thirds of the patients who were positive for HBV surface antigen had normal or slightly elevated serum aminotransferases. Under current practices HBV and HCV serology would not have been done. HBV and HCV viral loads were not assessed; therefore occult infection could have been missed, especially in the 10.6% of patients carrying the isolated HBV core antibody. Serology is necessary in South Africa to determine which patients would benefit from vaccination and whose care would improve with the use tenofovir (TDF)/3TC as backbone first-line therapy if co-infected HBV.