Genetic Diversity and Prevalence of Hepatitis B among Rural HIV Infected Populations Receiving Antiretroviral Therapy in Kenya

Abstract

Hepatitis B virus infection can result to an aggressive liver disease.  It is estimated that two billion people worldwide have been exposed to HBV infection, with 150 million chronically infected. Of those chronically infected, an estimated 1% are also infected with Human Immunodeficiency Virus (HIV). Infection with HIV accelerates progression of HBV to both chronic and development of liver complications. This study aimed at determining the genetic diversity and prevalence of hepatitis B infection in HIV infected persons receiving antiretroviral care in a level 4 hospital, in rural Kenya. A cross-sectional study was conducted among 413 study participants. Structured questionnaires were used to capture social demographic data whereas plasma samples were tested for hepatitis B using HBsAg. Positive samples were then genotyped to establish the circulating HBV genotypes and finally sequenced to screen for mutations and establish potential resistance to the recommended HBV treatment regimen.  An overall prevalence of HBV-HIV co infection was established at 3.9%. Genotype A was the most common (92.3%), while the remaining 7.7% all belonged to genotype D. Mutations at S207N (associated with immune escape and hepatic carcinoma and liver cirrhosis), N122H (associated with Occult Hepatitis B) as well as M129L and V163I (both associated with resistance to Lamivudine and Telbivudine) were identified in high frequencies. These results demonstrate the negative impact of HIV/HBV co-infection in the progression to liver complications as well as raises questions in the continued use of Lamivudine and Telbivudine based drugs in the management of HBV in the HIV infected populations, especially in the low and middle income countries, where out of pocket treatments remain beyond reach of the general population.

Keywords: Hepatitis B Virus, Human immunodeficiency virus, Lamivudine, Telbivudine, Hepatocellular carcinoma, Cirrhosis, LMIC

DOI: 10.7176/JBAH/15-3-03

Publication date:August 31^st 2025