Abstract

As a result of shared routes of transmission, hepatitis B virus (HBV) and human immuno deficiency virus (HIV) coinfection is common in the Cameroon, affecting 15% to 30% of HIV-infected persons. In most studies, coinfection with HIV has been associated with accelerated progression of HBV-related liver disease. Moreover, antiretroviral therapy (ART) has led to a marked decline in most opportunistic illnesses, and HBV infection has emerged as an important cause of morbidity and mortality in HIV-infected persons.

Indeed, data from nationwide surveillance of death certificates in the Cameroon indicate that the proportion of liver-related deaths increased three- to four-fold in HIV-infected persons in the last decade. In some settings, complications of HBV-related liver disease have been reported to be the leading cause of hospitalization and death among HIVinfected persons (J Acquir Immune Defic Syndr. 1987-1999).

In the era of antiretroviral therapy (ART), liver disease has emerged as an important cause of death among persons with human immunodeficiency virus (HIV)/hepatitis B virus (HBV) coinfection (Oyeyemi and Amugo, 2015). Both diseases represent key threats to public health. Hepatitis B Virus and HIV are two of the most prevalent and important infectious virus worldwide with potential cause of immunosuppression caused by HBV being a debilitating liver disease.

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

As a result of shared routes of transmission, hepatitis B virus (HBV) and human immuno deficiency virus (HIV) coinfection is common in the Cameroon, affecting 15% to 30% of HIV-infected persons. In most studies, coinfection with HIV has been associated with accelerated progression of HBV-related liver disease.

Moreover, antiretroviral therapy (ART) has led to a marked decline in most opportunistic illnesses, and HBV infection has emerged as an important cause of morbidity and mortality in HIV-infected persons.

Indeed, data from nationwide surveillance of death certificates in the Cameroon indicate that the proportion of liver-related deaths increased three- to four-fold in HIV-infected persons in the last decade. In some settings, complications of HBV-related liver disease have been reported to be the leading cause of hospitalization and death among HIV infected persons (J Acquir Immune Defic Syndr. 1987-1999).

Although the impact of ART on HIV disease has been remarkable, the impact on liver disease in confected patients remains unknown. Although it is possible that ART can attenuate liver disease progression through the reversal or prevention of HIV-related immunosuppression, it is also plausible that antiretroviral use may exacerbate liver disease. In fact, significant liver enzyme elevations (grade 3 or 4 hepatotoxicity) are observed in approximately 5% to 10% of persons taking a new antiretroviral regimen (WHO, 2004).

Furthermore, the incidence of ART-associated hepatoxicity is approximately threefold greater in HIV/HBV coinfected persons than in persons without hepatitisC. Although many liver enzyme elevations resolve even when ART is continued, the effect of ART use on the progression of HBV-related liver disease is uncertain. Hepatologists and HIV care providers

 

are increasingly faced with managing liver disease in HIV/HBV-coinfected patients receiving ART. However, data regarding the prevalence of significant liver disease and its relationship to ART are needed. The objectives of this study were to estimate the burden of liver disease among HIV/HBV coinfected persons receiving ART and to evaluate if liver disease is associated with factors that we could identify (and possibly modify), such as ART-related liver enzyme elevations (LEEs) (J Acquire Immune Defic Syndr. 1987-1999).

Both hepatitis B virus (HBV) and the human immunodeficiency virus (HIV) are major public health concerns worldwide due to their high prevalence’s, morbidity and mortality. This is aggravated by the co-infection with both viruses, as one accelerates the course of the other (WHO, 2020).

The hepatitis B virus is one of a major cause of chronic liver disease, and a leading cause of non-AIDS related death among persons infected with HIV in sub-Saharan Africa (WHO, 2020). Since the introduction of highly active antiretroviral therapy, a decline in the mortality in HIV-infected persons from opportunistic infections has been observed; in contrast, there has been a significant increase in morbidity and mortality of HIV-infected persons related to HBV infection [2, 5]. Globally, 20–30% of the 34 million persons living with HIV/AIDS are co-infected with HBV [8]. According to WHO, Africa bears the highest prevalence of chronic HBV of 5.3%. The prevalence of chronic hepatitis C in Cameroon is estimated to about 13% [10]. The prevalence of HBV in Cameroon varies widely between

12.5 and 23.9% depending on the study population (WHO, 2020). A national prevalence of HIV of 4.3% was observed in 2011, with the general population of southern Cameroon displaying the highest prevalence of HIV of 10.6% (CDC, 2019.

The prevalence of HBV/HIV co-infection varies between 0.0 and 7.2% among the different Cameroonian population. Only a single study has evaluated the prevalence of HBV and HIV co-infection among the rural population. With the aim of contributing to the body of knowledge on this area in Cameroon, we carried out this study to evaluate the magnitude of HBV/HIV co-infection in a rural community in the South Region of Cameroon (Balogun et al., 2012; WHO, 2020).

1.2 Statement of the Problem

In the era of antiretroviral therapy (ART), liver disease has emerged as an important cause of death among persons with human immunodeficiency virus (HIV)/hepatitis B virus (HBV) coinfection (Oyeyemi and Amugo, 2015).

Both diseases represent key threats to public health. Hepatitis B Virus and HIV are two of the most prevalent and important infectious viruses worldwide with potential cause of immunosuppression caused by HBV being a debilitating liver disease. While there is no information on the effect on antiretroviral therapy on coinfection of these two virus in Buea South West Regional of Cameroon. This are the necessary needs for this work to be carried out.

1.3. Objectives of the Study

1.3.1 General Objective

 

The objective of this study was to estimate the burden of liver disease and evaluate determinants of liver fibrosis and neuroinflammatory activity among HIV/HBV coinfected patients receiving ART.

1.3.2 Specific Objectives

1. To evaluate if liver disease is associated with factors that we could identify (and possibly modify), such as ART-related liver enzyme elevations
2. To estimate the burden of liver disease and evaluate determinants of liver fibrosis and neuroinflammatory activity among HIV/HBV coinfected patients receiving ART.
3. To determine the mean CD4 and liver enzymes levels and their association with HIV mono-infection and HIV/HBV co-infection.

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