A comparison of human immunodeficiency virus (HIV) seropositivity and hepatitis B surface antigenemia (HBs Ag) among the same group of apparently healthy pregnant women in Lagos, Nigeria: a preliminary report

Seroprevalence of hepatitis B virus serological markers among pregnant Nigerian women

Background:

Chronic hepatitis B infection is a global problem; however, Asia and sub-Saharan Africa are most affected by it. Hepatitis B status of pregnant women is essential for the effective management of the disease and prevention of mother to child transmission.

Materials and Methods:

The study was conducted at the antenatal care unit of four hospitals within Kaduna Metropolis, Nigeria, between August and December 2011. After obtaining ethical clearance, blood samples were collected from 800 consenting pregnant women, the plasma were screened for hepatitis B surface antigen (HBsAg) using first response HBsAg card and the reactive sera were confirmed with enzyme-linked immunosorbent assay. Other serological markers of hepatitis B virus (HBV) were detected using the one-step HBV multi-5 test kit.

Results:

Of the 800 pregnant women screened, 31 (3.9%) tested positive for HBsAg. Only one of the 31 HBsAg positive women had developed the hepatitis B surface antibody, 16 (51.6%) had the envelop antibody, 18 (58.1%) had the hepatitis B core antibody (anti-HBc), and two (6.5%) had hepatitis B envelop antigen (HBeAg). The highest prevalence of HBsAg was recorded among women in age group 21–25 years old (P = 0.968). Similarly, married women (P = 0.772), women in their second trimester of pregnancy (P = 0.938), women with tertiary education (P = 0.972), women from the South-East geopolitical zone (P = 0.250) and those whose husbands were in polygamous relationships (P = 0.944) had the highest seroprevalence of HBsAg.

Conclusion:

HBV was detected with a prevalence of 3.9% among pregnant women in Kaduna Metropolis, Nigeria. About 96.8% (29) of the reactive women had HBeAg negative chronic hepatitis while 6.5% (2) had HBeAg positive chronic hepatitis B infection. About 58.1% of the women had anti-HBc, hence, did not have immunity and probably had chronic infection with reduced risk of vertical transmission. Pregnant women should be screened for HBsAg at the first antenatal clinic visit for appropriate clinical management and effective prevention of vertical transmission.

Prevalence, correlates and pattern of Hepatitis B among antenatal clinic attenders in Yaounde-Cameroon: is perinatal transmission of HBV neglected in Cameroon?

BACKGROUND

Few studies have evaluated the prevalence of HBV in the general Cameroonian population or among antenatal attendants. The aim of this study was to determine the prevalence, correlates and patterns of Hepatitis B surface antigen among pregnant women attending antenatal care in Yaounde-Cameroon.

METHODS

This was a cross-sectional multicenter study carried out in a referral hospital and two secondary hospitals in Yaounde, the capital of Cameroon. The study lasted 15 months (March 2011 to June 2012), and recruited 959 pregnant women. Patient recruitment was consecutive. The HBsAg was tested using the Monalisa HBsAg Ultra ELISA kit. Other hepatitis B markers were equally tested.

RESULTS

The prevalence of hepatitis B infection (HBsAg) among antenatal clinic attenders in our setting was 7.7%. Amongst these women, just 5.4% were previously aware of their HBsAg status. The rate of HBV infectivity was high, with 28% of HBsAg positive women having evidence of HBeAg in their plasma, and up to 45.8% of these women lacking antibodies against hepatitis B e antigen (anti-HBe). About 41% of the pregnant women had had previous contact with HBV as evidenced by the positive status for anti-HBc.

CONCLUSION

The prevalence of hepatitis B among pregnant women in Cameroon is high, and the pattern tends towards high infectivity and therefore increased risk of perinatal HBV transmission. These highlight the need to step up preventive efforts against hepatitis B infection and perinatal HBV transmission in our community.

Prevalence, correlates and pattern of hepatitis B surface antigen in a low resource setting

BACKGROUND

Hepatitis B virus (HBV) infection in Nigeria has remained a Public Health issue. It is a major cause of mortality, especially in developing countries. Vertical transmission of hepatitis B virus infection is thought to be a major route of transmission in low resource areas. In spite of this, routine antenatal screening for hepatitis B infection is not yet practiced in many Nigerian hospitals. This paper present the findings of a study conducted among antenatal women in Nnewi, Nigeria.

METHODS

It was a cross-sectional study carried out over a 3-month period (August-October, 2009). Recruitment of 480 women attending antenatal clinics in Nnewi, Nigeria was done by simple random sampling using computer generated random numbers. HBsAg screening was done using rapid ELISA Kits. Statistical analysis was computed using STATA 11 package. The results were subjected to analysis using cross tabulations to explore statistical relationships between variables. Chi square test was used to explore proportional relationship between groups. The level of statistical significance was set at p < 0.05 (providing 95% confidence interval).

RESULTS

Four hundred and eighty pregnant women were recruited into the study. Of these, 40 tested positive to HBsAg, accounting for 8.3% of the sample population. The age of the subjects studied varied from 14 to 45 years (mean age--24.3 years) while the mean parity was 2.18. The HIV/HBV co-infection rate was 4.2%. The vertical transmission rate was 51.6%. There were statistically significant relationships between HBV infection and previous history of tribal marks/tattoos (χ2 = 27.39, P = 0.001, df = 1), history of contact with previously infected HBV patients (χ2 = 23.11, P = 0.001, df = 1) and occupation of the women (χ2 = 51.22, P = 0.001, df = 1). Multiple sexual partners, blood transfusion, dental manipulations, sharing of sharps/needles, and circumcision were not significant modes of transmission. There was no statistically significant relationship between maternal age, educational level and HBV infection.

CONCLUSION

The authors argued that hepatitis B screening in pregnancy should be made routine practice in Nigeria because of the low pick up rate of the infection based only on risk factors for the disease.

Risk factors for hepatitis B infection during pregnancy in a Nigerian obstetric population

We aimed to assess the risk factors for hepatitis B infection among pregnant women in Enugu, southeast Nigeria. This was a prospective case-control study of risk factors for hepatitis B surface antigen positivity among pregnant women seen in two tertiary health institutions in Enugu, southeast Nigeria. It was carried out over an 8-month period, January - August 2005. Of the 1,499 pregnant women attending the antenatal clinic, 4.6% (n = 69) were seropositive for hepatitis B surface antigen. A total of 35 (50.7%) HBsAg positive women and 71 negative controls were interviewed. The risk factors for HBsAg were present in 71% (n = 25) of the positive cases, while only 27% (n = 19) of the negative cases had risk factors. The significant risk factors for HBsAg positivity were higher mean parity, higher number of sexual partners since sexual debut, polygamy and previous positive history of sexually transmitted diseases (STD) (p < 0.05). The two groups did not differ with respect to presence of tattoo or scarification marks, positive history of jaundice or contact with a jaundiced patient, previous blood transfusion or contact with blood products, intravenous drug abuse or sharing personal instruments (p > 0.05). Screening pregnant women for hepatitis B infection on the basis of presence of risk factors may not effective. Universal antenatal screening for HBsAg, health education aimed at reducing risk factors and immunisation of all newborn and those at risk of hepatitis B is advocated.

Anti-retroviral treatment in Nigeria: a review

Research studies in Nigeria have been done primarily in the areas of epidemiology, clinical practice, virology, and laboratory diagnosis. Therapy for infection with human immunodeficiency virus (HIV) types 1 and 2 has largely focussed on the treatment of the HIV disease (AIDS) rather than the infection. Therefore, opportunistic infections such as tuberculosis, diarrhea, Herpes zoster, and other skin conditions, and tumors (Kaposi's sarcoma) are essentially the targets for therapy. Two reasons are responsible for the dearth of data on anti-retroviral therapy in Nigeria: there was scepticism about zidovudine, the first anti-retroviral drug to be developed, because of its toxicity, and the subsequent reluctance of the Federal Government to allow it into the country. The other reason was the prohibitive cost, making it impossible for patients to afford. That notwithstanding, there have been several uncoordinated and unpublished clinical trials by hospitals in the private sector, as expected, without firm laboratory monitoring or back-up. This review discusses such attempts and the claims of traditional medicine practitioners, as well as pilot studies on private patients with the combination therapy of zidovudine and lamivudine, which agents were allowed into the country in the late 1990s. The patients showed appreciable rises in their CD4 counts, an indirect way of monitoring viral load. This finding was corroborated with results of clinical wellbeing, indicating that they benefitted from the administration of zidovudine and lamivudine.

Seroprevalence and coprevalence of HIV and HBsAg in Nigerian children with/without protein energy malnutrition

In order to assess the seroprevalence and coprevalence of hepatitis-B surface antigen (HBsAg), human immunodeficiency virus-1 and -2 (HIV-1 and -2) antibodies in Nigerian children with/without protein energy malnutrition (PEM), we studied plasma specimens of 206 children with PEM and 200 apparently healthy reference children aged between 1 and 3 years by enzyme-linked immunosorbent assays (ELISA). HIV-seropositive cases were confirmed by immunoblotting (IB). Of the children studied, eight (4%) of the healthy and four (1.9%) of the malnourished (P = 0.22, Fisher's exact test) were positive for HIV-1 antibodies, 40 (20%) of the healthy and 54 (26%) of the malnourished (P = 0.14) were positive for HBsAg, and five (2.5%) of the healthy and four (1.9%) of the malnourished (P = 0.70) were positive for both HIV-1/HBsAg. No case of HIV-2 antibodies was found. While the seroprevalence of HBsAg was higher in the malnourished subjects, the reverse was the case with HIV antibodies. However, all the four HIV-1-positive malnourished children and five of eight of the HIV-1-positive reference children were simultaneously positive for HBsAg. This is the first epidemiological report on the seroprevalence and coprevalence of HIV and HBsAg in apparently healthy and malnourished Nigerian children.