Comparing Serological Markers of Hepatitis B Virus Infection among People Living with HIV/AIDS and HIV Seronegative Individuals

Research Article

J Hepat Res. 2015;2(1): 1022.

Comparing Serological Markers of Hepatitis B Virus Infection among People Living with HIV/AIDS and HIV Seronegative Individuals

Ijarotimi O1*, Ijarotimi AO2, Ndububa DA1, Adekanle O1, Ezejiorfor OI4, Oripelaye MM3, Umoru BI1 and Oguntoye OO1

1Department Of Medicine, Obafemi Awolowo University Teahing Hospitals Complex, Nigeria

2Department Of Obstetrics And Gynecology, Obafemi Awolowo University Teahing Hospitals Complex, Nigeria

3Department Of Dermatology And Venerology, Obafemi Awolowo University Teahing Hospitals Complex, Nigeria

4Department Of Dermatology And Venerology, Nnamdi Azikiwe University Teaching Hospital, Nigeria

*Corresponding author: Ijarotimi Oluwasegun, Department of Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, PMB 5538, Nigeria

Received: February 02, 2015; Accepted: April 23, 2015; Published: May 04, 2015


Background: HIV has a negative effect on the course/progression of Hepatitis B infection making chronicity more likely in acute infections, with increased risk of cirrhosis, Hepatocellular Carcinoma (HCC) and decompensated liver disease in chronic infections.

Objective: The study was conducted to show the prevalence of Hepatitis B infection in HIV positive individuals compared to HIV negative individuals.

Methods: Two hundred subjects consisting of 100 HIV infected individuals and 100 HIV negative healthy controls were recruited. Serological markers of Hepatitis B infection (HBsAg, HBeAg, Anti-HBe, Anti-HBc and Anti-HBs) using a rapid immunoassay test kit (ACON) were tested for in all of them.

Results: Fifteen (15%) of the HIV infected cases compared to 10% of the healthy controls were positive for HBsAg (P =0.393). HBeAg was positive in 10% of the cases and 4% of the controls (P = 0.164). Anti-HBs positivity was found in 8%of the HIV infected cases while 25% of the healthy controls were positive (P = 0.002). Twenty-two (22%) of the HIV infected cases were positive for Anti-HBe compared to 56%of the healthy controls ( P = 0.000) . Anti-HBc was positive in 82%of the cases and73% of the healthy controls (P = 0.175).

Conclusion: HIV infected persons are less likely to clear HBV infection and develop natural immunity to it compared to the HIV negative controls. The very high level of Anti-HBc seen in both groups showed Nigeria is a highly endemic society for hepatitis B infection.

Keywords: HBsAg; Anti-HBs; HBeAg; Anti-HBe; Anti-HBc; HIV; HBV


HBsAg: Hepatitis B Surface Antigen; Anti-HBs: Antibody to Hepatitis B Surface Antigen; HBeAg: Hepatitis B e Antigen; Anti-HBe: Antibody to Hepatitis B e Antigen; Anti-HBc: Antibody to Hepatitis B core Antigen; HIV: Human Immunodeficiency Virus; HBV: Hepatitis B Virus; PLWHA: People Living With HIV and Acquired Immune Deficiency Syndrome; HCC: Hepatocellular Carcinoma; HAART: Highly Active Antiretroviral Therapy; STI: Sexually Transmitted Disease; IRIS: Immune Reconstituition Syndrome; ELISA: Enzyme Linked Immunoadsorbent Assay


Human Immunodeficiency Virus (HIV) and Hepatitis B Virus (HBV) infection share similar routes of transmission and hence readily co-exist in the same individual.

HIV has a negative impact on the course of Hepatitis B Infection i.e increased tendency to chronicity [1], increased liver related morbidity and mortality [2]. HIV and HBV co-infection also increases HBV replication, hepatitis flares and risk of progression to cirrhosis and Hepatocellular Carcinoma (HCC) [3].

There is therefore, a need to screen People Living with HIV and Acquired Immune Deficiency Syndrome (PLWHA) for possible HBV infection.

Screening for HBV infection in HIV positive individuals using HBsAg alone may not be enough because of the known risk of reverse seroconversion and occult hepatitis B infection in such individuals [4]. Studies have shown increased prevalence of HBV infection, both past and active infection in PLWHA when additional markers i.e antibody to the surface antigen (Anti-HBs) and antibody to the core antigen (Anti-HBc) were screened for in conjunction with HBsAg [5,6].

With the use of Highly Active Antiretroviral Therapy (HAART) , liver failure has emerged as a major cause of death in HIV/HBV coinfected individuals [7] especially in HBV endemic areas (areas with HBV prevalence greater than 8%). It is likely that decompensated liver disease in the setting of chronic hepatitis B will emerge as a greater problem due to Immune Reconstituition Syndrome (IRIS). Thus, it is important to understand HIV/HBV co-infection in HBV endemic regions because of the expanding role of antiretroviral programmes especially in view of the implications of using HAART agents that also possess anti-HBV activity.


The aim of this study is to know the prevalence of HBV infection in PLWHA as compared to HIV negative individuals using other serological markers of HBV infection in addition to Hepatitis B Surface Antigen (HBsAg).

Materials and Methods

This was a comparative observational study, carried out at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Osun State, Nigeria.

The study was done using people who were18years and above, who were seropositive for HIV 1 and/or 2 (ELISA method) and were treatment naive as at the time of recruitment. They were recruited at the Sexually Transmitted Infection (STI) Clinic of OAUTHC. Age and sex matched controls (HIV negative individuals) of equal number were also recruited for the study. These controls were recruited amongst pregnant women at the Antenatal Clinic and amongst blood donors at the Hematology Department, OAUTHC Ile-Ife. They all gave informed consent. Individuals with previous active immunization against hepatitis B virus infection were excluded from the study.

Eligible patients were serially recruited until sample size was exhausted.

The sample size was 100 each (making a total of 200) for both the HIV infected cases and HIV uninfected controls.

Each of the subjects was interviewed using a questionnaire focusing on demographic data and relevant history to the study. Each of the subjects had 5mls of blood (peripheral venous blood) drawn from them (venepuncture) using 5cc needle and syringe via a peripheral vein. The blood was centrifuged and the serum separated from the cells, few drops were placed on each of the five small holes on each test kit plate representing the five parameters that were being tested [the hepatitis B test kit is a one step Hepatitis B Virus Combo Test Device, trade name ACON, (CAT: IHB-355 LOT: HBV 0050004 EXP 2012-05) it works by the rapid immunoassay method]. The serum moved along a chromatographic column connected to each of the five small holes and the results were then read. Thechromatographic column had two regions, a control and a test region from where the results were read. The investigations done on the subjects were HBsAg, Anti-HBs, Anti-HBc, HBeAg, and Anti- HBe.

The appearance of two lines in the chromatographic column, one in the control region and the other in the test region signified a positive test result for HBsAg, Anti-HBs and HBeAg (presence of the markers in the plasma of the subject) while the appearance of only one line in the control region signified a negative test result (absence of the markers in the plasma of the subject). The appearance of just a single line in the control region signified a positive test result for Anti-HBe and Anti-HBc while appearance of two lines both in the control and test region signified a negative test result.

Data was represented using descriptive statistics such as table and inferential statistics such as the chi square test (×2). Means and standard deviation were also used for continuous variables. Presence of all the serological markers of hepatitis B infection were compared between HIV positive and HIV negative subjects. P value less than or equal to 0.05 was taken as statistical significance.


The study population comprised of 100 HIV positive subjects (cases) and 100 HIV negative subjects (controls) (Table 1). One hundred and ninety (95%) of the study population were under the age of 50 years, only 10 (5%) were 50years and above. The modal age range was 30years to 39years. The age range amongst the cases was 24years to 64years with a mean age of 35.81 ± 9.311 while the age range amongst the control was 18years to 55years with a mean age of 32.70 ± 6.882. (P value was 0.08).