Antenatal screening for hepatitis B virus in HIV-infected and uninfected pregnant women in the Tshwane district of South Africa

Abstract

Background. Despite enormous strides in preventing hepatitis B virus (HBV) infection, perinatal transmission still contributes significantly to HBV epidemiology worldwide; this could account for approximately 50% of chronically infected individuals.

Objective. To assess the need for HBV screening in antenatal clinics in the HIV/AIDS era.

Methods. This was a retrospective study conducted at the antenatal clinic of 1 Military Hospital, Tshwane, South Africa. Laboratory data for HBV, HIV and CD4 count were obtained and analysed for the period January 2008 ­ December 2013.

Results. A total of 2 513 patients’ results were retrieved and 2 368 patients were enrolled as both their HBV and HIV serology results were available. The mean age of participants was 29 years (range 14 ­ 46). HIV prevalence in this study was 20.5% (95% confidence interval (CI) 0.189 ­ 0.222). The median CD4 count in HIV­infected patients was 522 cells/μL (interquartile range 370 ­ 711). There was an overall HBV prevalence of 0.8% (95% CI 0.005 ­ 0.011). The hepatitis B surface antigen (HBsAg) prevalence was significantly higher (2.1%) among HIV co­infected compared with HIV­uninfected patients (0.4%) (p=0.0001). Hepatitis e antigen (HBeAg) positivity was 30% in the HIV co­infected compared with 37.6% in the HIV­uninfected individuals (p=0.7400).

Conclusion. This study showed a significantly higher HBV prevalence in HIV­infected compared with HIV­uninfected patients. The comparable HBeAg prevalence between the two groups indicates that both were at an increased risk of vertical transmission, therefore demonstrating a need for antenatal screening for HBV. Since antenatal screening is often not affordable in low­income countries, administration of HBV vaccine at birth is needed for prevention of vertical transmission.