HIV, Hepatitis B, and Hepatitis C in Zambia
Identifieur interne : 002642 ( Pmc/Corpus ); précédent : 002641; suivant : 002643HIV, Hepatitis B, and Hepatitis C in Zambia
Auteurs : Kenneth C. Kapembwa ; Jason D. Goldman ; Shabir Lakhi ; Yolan Banda ; Kasonde Bowa ; Sten H. Vermund ; Joseph Mulenga ; David Chama ; Benjamin H. ChiSource :
- Journal of Global Infectious Diseases [ 0974-777X ] ; 2011.
Abstract
Epidemiologic data of HIV and viral hepatitis coinfection are needed in sub-Saharan Africa to guide health policy for hepatitis screening and optimized antiretroviral therapy (ART).
We screened 323 HIV-infected, ART-eligible adults for hepatitis B surface antigen (HBsAg) and hepatitis C antibody (HCV Ab) at a tertiary hospital in Lusaka, Zambia. We collected basic demographic, medical, and laboratory data to determine predictors for coinfection.
Of 323 enrolled patients, 32 (9.9%; 95% CI=6.7–13.2%) were HBsAg positive, while 4 (1.2%; 95% CI=0.03–2.4%) were HCV Ab positive. Patients with hepatitis B coinfection were more likely to be <40 years (84.4% vs. 61.4%;
HIV and hepatitis B coinfection was common among patients initiating ART at this tertiary care facility. Routine screening for hepatitis B should be considered for HIV-infected persons in southern Africa.
Url:
DOI: 10.4103/0974-777X.83534
PubMed: 21887060
PubMed Central: 3162815
Links to Exploration step
PMC:3162815Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">HIV, Hepatitis B, and Hepatitis C in Zambia</title><author><name sortKey="Kapembwa, Kenneth C" sort="Kapembwa, Kenneth C" uniqKey="Kapembwa K" first="Kenneth C" last="Kapembwa">Kenneth C. Kapembwa</name><affiliation><nlm:aff id="aff1"><italic>Department of Internal Medicine, School of Medicine, University of Zambia, Lusaka, Zambia</italic></nlm:aff></affiliation><affiliation><nlm:aff id="aff2"><italic>Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia</italic></nlm:aff></affiliation></author><author><name sortKey="Goldman, Jason D" sort="Goldman, Jason D" uniqKey="Goldman J" first="Jason D" last="Goldman">Jason D. Goldman</name><affiliation><nlm:aff id="aff3"><italic>Department of Medicine, School of Medicine, University of Washington, Seattle, WA</italic></nlm:aff></affiliation><affiliation><nlm:aff id="aff4"><italic>Centre for Infectious Disease Research in Zambia, Lusaka, Zambia</italic></nlm:aff></affiliation></author><author><name sortKey="Lakhi, Shabir" sort="Lakhi, Shabir" uniqKey="Lakhi S" first="Shabir" last="Lakhi">Shabir Lakhi</name><affiliation><nlm:aff id="aff1"><italic>Department of Internal Medicine, School of Medicine, University of Zambia, Lusaka, Zambia</italic></nlm:aff></affiliation><affiliation><nlm:aff id="aff2"><italic>Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia</italic></nlm:aff></affiliation></author><author><name sortKey="Banda, Yolan" sort="Banda, Yolan" uniqKey="Banda Y" first="Yolan" last="Banda">Yolan Banda</name><affiliation><nlm:aff id="aff4"><italic>Centre for Infectious Disease Research in Zambia, Lusaka, Zambia</italic></nlm:aff></affiliation></author><author><name sortKey="Bowa, Kasonde" sort="Bowa, Kasonde" uniqKey="Bowa K" first="Kasonde" last="Bowa">Kasonde Bowa</name><affiliation><nlm:aff id="aff5"><italic>Department of Surgery, School of Medicine, University Teaching Hospital, Lusaka, Zambia</italic></nlm:aff></affiliation></author><author><name sortKey="Vermund, Sten H" sort="Vermund, Sten H" uniqKey="Vermund S" first="Sten H" last="Vermund">Sten H. Vermund</name><affiliation><nlm:aff id="aff4"><italic>Centre for Infectious Disease Research in Zambia, Lusaka, Zambia</italic></nlm:aff></affiliation><affiliation><nlm:aff id="aff6"><italic>Institute of Global Health and Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN</italic></nlm:aff></affiliation></author><author><name sortKey="Mulenga, Joseph" sort="Mulenga, Joseph" uniqKey="Mulenga J" first="Joseph" last="Mulenga">Joseph Mulenga</name><affiliation><nlm:aff id="aff7"><italic>Zambia National Blood Transfusion Service, Lusaka, Zambia</italic></nlm:aff></affiliation></author><author><name sortKey="Chama, David" sort="Chama, David" uniqKey="Chama D" first="David" last="Chama">David Chama</name><affiliation><nlm:aff id="aff7"><italic>Zambia National Blood Transfusion Service, Lusaka, Zambia</italic></nlm:aff></affiliation></author><author><name sortKey="Chi, Benjamin H" sort="Chi, Benjamin H" uniqKey="Chi B" first="Benjamin H" last="Chi">Benjamin H. Chi</name><affiliation><nlm:aff id="aff4"><italic>Centre for Infectious Disease Research in Zambia, Lusaka, Zambia</italic></nlm:aff></affiliation><affiliation><nlm:aff id="aff8"><italic>Department of Obstetrics and Gynecology, School of Medicine, University of Alabama, Birmingham, AL, USA</italic></nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">21887060</idno><idno type="pmc">3162815</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3162815</idno><idno type="RBID">PMC:3162815</idno><idno type="doi">10.4103/0974-777X.83534</idno><date when="2011">2011</date><idno type="wicri:Area/Pmc/Corpus">002642</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002642</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">HIV, Hepatitis B, and Hepatitis C in Zambia</title><author><name sortKey="Kapembwa, Kenneth C" sort="Kapembwa, Kenneth C" uniqKey="Kapembwa K" first="Kenneth C" last="Kapembwa">Kenneth C. Kapembwa</name><affiliation><nlm:aff id="aff1"><italic>Department of Internal Medicine, School of Medicine, University of Zambia, Lusaka, Zambia</italic></nlm:aff></affiliation><affiliation><nlm:aff id="aff2"><italic>Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia</italic></nlm:aff></affiliation></author><author><name sortKey="Goldman, Jason D" sort="Goldman, Jason D" uniqKey="Goldman J" first="Jason D" last="Goldman">Jason D. Goldman</name><affiliation><nlm:aff id="aff3"><italic>Department of Medicine, School of Medicine, University of Washington, Seattle, WA</italic></nlm:aff></affiliation><affiliation><nlm:aff id="aff4"><italic>Centre for Infectious Disease Research in Zambia, Lusaka, Zambia</italic></nlm:aff></affiliation></author><author><name sortKey="Lakhi, Shabir" sort="Lakhi, Shabir" uniqKey="Lakhi S" first="Shabir" last="Lakhi">Shabir Lakhi</name><affiliation><nlm:aff id="aff1"><italic>Department of Internal Medicine, School of Medicine, University of Zambia, Lusaka, Zambia</italic></nlm:aff></affiliation><affiliation><nlm:aff id="aff2"><italic>Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia</italic></nlm:aff></affiliation></author><author><name sortKey="Banda, Yolan" sort="Banda, Yolan" uniqKey="Banda Y" first="Yolan" last="Banda">Yolan Banda</name><affiliation><nlm:aff id="aff4"><italic>Centre for Infectious Disease Research in Zambia, Lusaka, Zambia</italic></nlm:aff></affiliation></author><author><name sortKey="Bowa, Kasonde" sort="Bowa, Kasonde" uniqKey="Bowa K" first="Kasonde" last="Bowa">Kasonde Bowa</name><affiliation><nlm:aff id="aff5"><italic>Department of Surgery, School of Medicine, University Teaching Hospital, Lusaka, Zambia</italic></nlm:aff></affiliation></author><author><name sortKey="Vermund, Sten H" sort="Vermund, Sten H" uniqKey="Vermund S" first="Sten H" last="Vermund">Sten H. Vermund</name><affiliation><nlm:aff id="aff4"><italic>Centre for Infectious Disease Research in Zambia, Lusaka, Zambia</italic></nlm:aff></affiliation><affiliation><nlm:aff id="aff6"><italic>Institute of Global Health and Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN</italic></nlm:aff></affiliation></author><author><name sortKey="Mulenga, Joseph" sort="Mulenga, Joseph" uniqKey="Mulenga J" first="Joseph" last="Mulenga">Joseph Mulenga</name><affiliation><nlm:aff id="aff7"><italic>Zambia National Blood Transfusion Service, Lusaka, Zambia</italic></nlm:aff></affiliation></author><author><name sortKey="Chama, David" sort="Chama, David" uniqKey="Chama D" first="David" last="Chama">David Chama</name><affiliation><nlm:aff id="aff7"><italic>Zambia National Blood Transfusion Service, Lusaka, Zambia</italic></nlm:aff></affiliation></author><author><name sortKey="Chi, Benjamin H" sort="Chi, Benjamin H" uniqKey="Chi B" first="Benjamin H" last="Chi">Benjamin H. Chi</name><affiliation><nlm:aff id="aff4"><italic>Centre for Infectious Disease Research in Zambia, Lusaka, Zambia</italic></nlm:aff></affiliation><affiliation><nlm:aff id="aff8"><italic>Department of Obstetrics and Gynecology, School of Medicine, University of Alabama, Birmingham, AL, USA</italic></nlm:aff></affiliation></author></analytic><series><title level="j">Journal of Global Infectious Diseases</title><idno type="ISSN">0974-777X</idno><idno type="eISSN">0974-8245</idno><imprint><date when="2011">2011</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="st1"><title>Objectives</title><p>Epidemiologic data of HIV and viral hepatitis coinfection are needed in sub-Saharan Africa to guide health policy for hepatitis screening and optimized antiretroviral therapy (ART).</p></sec><sec id="st2"><title>Materials and Methods:</title><p>We screened 323 HIV-infected, ART-eligible adults for hepatitis B surface antigen (HBsAg) and hepatitis C antibody (HCV Ab) at a tertiary hospital in Lusaka, Zambia. We collected basic demographic, medical, and laboratory data to determine predictors for coinfection.</p></sec><sec id="st3"><title>Results:</title><p>Of 323 enrolled patients, 32 (9.9%; 95% CI=6.7–13.2%) were HBsAg positive, while 4 (1.2%; 95% CI=0.03–2.4%) were HCV Ab positive. Patients with hepatitis B coinfection were more likely to be <40 years (84.4% vs. 61.4%; <italic>P</italic>=0.01) when compared to those who were not coinfected. Patients with active hepatitis B were more likely to have mild to moderately elevated AST/ALT (40–199 IU/L, 15.8% vs. 5.4%; <italic>P</italic>=0.003). Highly elevated liver enzymes (>200 IU/L) was uncommon and did not differ between the two groups (3.4% vs. 2.3%; <italic>P</italic>=0.5). We were unable to determine predictors of hepatitis C infection due to the low prevalence of disease.</p></sec><sec id="st4"><title>Conclusions:</title><p>HIV and hepatitis B coinfection was common among patients initiating ART at this tertiary care facility. Routine screening for hepatitis B should be considered for HIV-infected persons in southern Africa.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Stringer, Js" uniqKey="Stringer J">JS Stringer</name></author><author><name sortKey="Zulu, I" uniqKey="Zulu I">I Zulu</name></author><author><name sortKey="Levy, J" uniqKey="Levy J">J Levy</name></author><author><name sortKey="Stringer, Em" uniqKey="Stringer E">EM Stringer</name></author><author><name sortKey="Mwango, A" uniqKey="Mwango A">A Mwango</name></author><author><name sortKey="Chi, Bh" uniqKey="Chi B">BH Chi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bolton Moore, C" uniqKey="Bolton Moore C">C Bolton-Moore</name></author><author><name sortKey="Mubiana Mbewe, M" uniqKey="Mubiana Mbewe M">M Mubiana-Mbewe</name></author><author><name sortKey="Cantrell, Ra" uniqKey="Cantrell R">RA Cantrell</name></author><author><name sortKey="Chintu, N" uniqKey="Chintu N">N Chintu</name></author><author><name sortKey="Stringer, Em" uniqKey="Stringer E">EM Stringer</name></author><author><name sortKey="Chi, Bh" uniqKey="Chi B">BH Chi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Sulkowski, Ms" uniqKey="Sulkowski M">MS Sulkowski</name></author><author><name sortKey="Thomas, Dl" uniqKey="Thomas D">DL Thomas</name></author><author><name sortKey="Mehta, Sh" uniqKey="Mehta S">SH Mehta</name></author><author><name sortKey="Chaisson, Re" uniqKey="Chaisson R">RE Chaisson</name></author><author><name sortKey="Moore, Rd" uniqKey="Moore R">RD Moore</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Martinez, E" uniqKey="Martinez E">E Martinez</name></author><author><name sortKey="Blanco, Jl" uniqKey="Blanco J">JL Blanco</name></author><author><name sortKey="Arnaiz, Ja" uniqKey="Arnaiz J">JA Arnaiz</name></author><author><name sortKey="Perez Cuevas, Jb" uniqKey="Perez Cuevas J">JB Perez-Cuevas</name></author><author><name sortKey="Mocroft, A" uniqKey="Mocroft A">A Mocroft</name></author><author><name sortKey="Cruceta, A" uniqKey="Cruceta A">A Cruceta</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="De Maat, Mm" uniqKey="De Maat M">MM de Maat</name></author><author><name sortKey="Ter Heine, R" uniqKey="Ter Heine R">R ter Heine</name></author><author><name sortKey="Van Gorp, Ec" uniqKey="Van Gorp E">EC van Gorp</name></author><author><name sortKey="Mulder, Jw" uniqKey="Mulder J">JW Mulder</name></author><author><name sortKey="Mairuhu, At" uniqKey="Mairuhu A">AT Mairuhu</name></author><author><name sortKey="Beijnen, Jh" uniqKey="Beijnen J">JH Beijnen</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Aceti, A" uniqKey="Aceti A">A Aceti</name></author><author><name sortKey="Pasquazzi, C" uniqKey="Pasquazzi C">C Pasquazzi</name></author><author><name sortKey="Zechini, B" uniqKey="Zechini B">B Zechini</name></author><author><name sortKey="De Bac, C" uniqKey="De Bac C">C De Bac</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Arribas, Jr" uniqKey="Arribas J">JR Arribas</name></author><author><name sortKey="Ibanez, C" uniqKey="Ibanez C">C Ibanez</name></author><author><name sortKey="Ruiz Antoran, B" uniqKey="Ruiz Antoran B">B Ruiz-Antoran</name></author><author><name sortKey="Pena, Jm" uniqKey="Pena J">JM Pena</name></author><author><name sortKey="Esteban Calvo, C" uniqKey="Esteban Calvo C">C Esteban-Calvo</name></author><author><name sortKey="Frias, J" uniqKey="Frias J">J Frias</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Oshitani, H" uniqKey="Oshitani H">H Oshitani</name></author><author><name sortKey="Kasolo, Fc" uniqKey="Kasolo F">FC Kasolo</name></author><author><name sortKey="Mpabalwani, M" uniqKey="Mpabalwani M">M Mpabalwani</name></author><author><name sortKey="Mizuta, K" uniqKey="Mizuta K">K Mizuta</name></author><author><name sortKey="Luo, Np" uniqKey="Luo N">NP Luo</name></author><author><name sortKey="Suzuki, H" uniqKey="Suzuki H">H Suzuki</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kasolo, F" uniqKey="Kasolo F">F Kasolo</name></author><author><name sortKey="Sakala, I" uniqKey="Sakala I">I Sakala</name></author><author><name sortKey="Baboo, K" uniqKey="Baboo K">K Baboo</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mwaba, P" uniqKey="Mwaba P">P Mwaba</name></author><author><name sortKey="Zulu, I" uniqKey="Zulu I">I Zulu</name></author><author><name sortKey="Kafula, T" uniqKey="Kafula T">T Kafula</name></author><author><name sortKey="Chisembele, M" uniqKey="Chisembele M">M Chisembele</name></author><author><name sortKey="Mtonga, V" uniqKey="Mtonga V">V Mtonga</name></author><author><name sortKey="Kankasa, C" uniqKey="Kankasa C">C Kankasa</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Morris, Mb" uniqKey="Morris M">MB Morris</name></author><author><name sortKey="Chapula, Bt" uniqKey="Chapula B">BT Chapula</name></author><author><name sortKey="Chi, Bh" uniqKey="Chi B">BH Chi</name></author><author><name sortKey="Mwango, A" uniqKey="Mwango A">A Mwango</name></author><author><name sortKey="Chi, Hf" uniqKey="Chi H">HF Chi</name></author><author><name sortKey="Mwanza, J" uniqKey="Mwanza J">J Mwanza</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Firnhaber, C" uniqKey="Firnhaber C">C Firnhaber</name></author><author><name sortKey="Reyneke, A" uniqKey="Reyneke A">A Reyneke</name></author><author><name sortKey="Schulze, D" uniqKey="Schulze D">D Schulze</name></author><author><name sortKey="Malope, B" uniqKey="Malope B">B Malope</name></author><author><name sortKey="Maskew, M" uniqKey="Maskew M">M Maskew</name></author><author><name sortKey="Macphail, P" uniqKey="Macphail P">P MacPhail</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Otegbayo, Ja" uniqKey="Otegbayo J">JA Otegbayo</name></author><author><name sortKey="Taiwo, Bo" uniqKey="Taiwo B">BO Taiwo</name></author><author><name sortKey="Akingbola, Ts" uniqKey="Akingbola T">TS Akingbola</name></author><author><name sortKey="Odaibo, Gn" uniqKey="Odaibo G">GN Odaibo</name></author><author><name sortKey="Adedapo, Ks" uniqKey="Adedapo K">KS Adedapo</name></author><author><name sortKey="Penugonda, S" uniqKey="Penugonda S">S Penugonda</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Diop Ndiaye, H" uniqKey="Diop Ndiaye H">H Diop-Ndiaye</name></author><author><name sortKey="Toure Kane, C" uniqKey="Toure Kane C">C Toure-Kane</name></author><author><name sortKey="Etard, Jf" uniqKey="Etard J">JF Etard</name></author><author><name sortKey="Lo, G" uniqKey="Lo G">G Lo</name></author><author><name sortKey="Diaw, P" uniqKey="Diaw P">P Diaw</name></author><author><name sortKey="Ngom Gueye, Nf" uniqKey="Ngom Gueye N">NF Ngom-Gueye</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Nagu, Tj" uniqKey="Nagu T">TJ Nagu</name></author><author><name sortKey="Bakari, M" uniqKey="Bakari M">M Bakari</name></author><author><name sortKey="Matee, M" uniqKey="Matee M">M Matee</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hadler, Sc" uniqKey="Hadler S">SC Hadler</name></author><author><name sortKey="Judson, Fn" uniqKey="Judson F">FN Judson</name></author><author><name sortKey="O Alley, Pm" uniqKey="O Alley P">PM O’Malley</name></author><author><name sortKey="Altman, Nl" uniqKey="Altman N">NL Altman</name></author><author><name sortKey="Penley, K" uniqKey="Penley K">K Penley</name></author><author><name sortKey="Buchbinder, S" uniqKey="Buchbinder S">S Buchbinder</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Colin, Jf" uniqKey="Colin J">JF Colin</name></author><author><name sortKey="Cazals Hatem, D" uniqKey="Cazals Hatem D">D Cazals-Hatem</name></author><author><name sortKey="Loriot, Ma" uniqKey="Loriot M">MA Loriot</name></author><author><name sortKey="Martinot Peignoux, M" uniqKey="Martinot Peignoux M">M Martinot-Peignoux</name></author><author><name sortKey="Pham, Bn" uniqKey="Pham B">BN Pham</name></author><author><name sortKey="Auperin, A" uniqKey="Auperin A">A Auperin</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Thio, Cl" uniqKey="Thio C">CL Thio</name></author><author><name sortKey="Seaberg, Ec" uniqKey="Seaberg E">EC Seaberg</name></author><author><name sortKey="Skolasky, R" uniqKey="Skolasky R">R Skolasky</name></author><author><name sortKey="Phair, J" uniqKey="Phair J">J Phair</name></author><author><name sortKey="Visscher, B" uniqKey="Visscher B">B Visscher</name></author><author><name sortKey="Munoz, A" uniqKey="Munoz A">A Munoz</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Puoti, M" uniqKey="Puoti M">M Puoti</name></author><author><name sortKey="Bruno, R" uniqKey="Bruno R">R Bruno</name></author><author><name sortKey="Soriano, V" uniqKey="Soriano V">V Soriano</name></author><author><name sortKey="Donato, F" uniqKey="Donato F">F Donato</name></author><author><name sortKey="Gaeta, Gb" uniqKey="Gaeta G">GB Gaeta</name></author><author><name sortKey="Quinzan, Gp" uniqKey="Quinzan G">GP Quinzan</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Nikolopoulos, Gk" uniqKey="Nikolopoulos G">GK Nikolopoulos</name></author><author><name sortKey="Paraskevis, D" uniqKey="Paraskevis D">D Paraskevis</name></author><author><name sortKey="Hatzitheodorou, E" uniqKey="Hatzitheodorou E">E Hatzitheodorou</name></author><author><name sortKey="Moschidis, Z" uniqKey="Moschidis Z">Z Moschidis</name></author><author><name sortKey="Sypsa, V" uniqKey="Sypsa V">V Sypsa</name></author><author><name sortKey="Zavitsanos, X" uniqKey="Zavitsanos X">X Zavitsanos</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kaplan, Je" uniqKey="Kaplan J">JE Kaplan</name></author><author><name sortKey="Benson, C" uniqKey="Benson C">C Benson</name></author><author><name sortKey="Holmes, Kh" uniqKey="Holmes K">KH Holmes</name></author><author><name sortKey="Brooks, Jt" uniqKey="Brooks J">JT Brooks</name></author><author><name sortKey="Pau, A" uniqKey="Pau A">A Pau</name></author><author><name sortKey="Masur, H" uniqKey="Masur H">H Masur</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Matthews, Gv" uniqKey="Matthews G">GV Matthews</name></author><author><name sortKey="Seaberg, E" uniqKey="Seaberg E">E Seaberg</name></author><author><name sortKey="Dore, Gj" uniqKey="Dore G">GJ Dore</name></author><author><name sortKey="Bowden, S" uniqKey="Bowden S">S Bowden</name></author><author><name sortKey="Lewin, Sr" uniqKey="Lewin S">SR Lewin</name></author><author><name sortKey="Sasadeusz, J" uniqKey="Sasadeusz J">J Sasadeusz</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Matthews, Gv" uniqKey="Matthews G">GV Matthews</name></author><author><name sortKey="Avihingsanon, A" uniqKey="Avihingsanon A">A Avihingsanon</name></author><author><name sortKey="Lewin, Sr" uniqKey="Lewin S">SR Lewin</name></author><author><name sortKey="Amin, J" uniqKey="Amin J">J Amin</name></author><author><name sortKey="Rerknimitr, R" uniqKey="Rerknimitr R">R Rerknimitr</name></author><author><name sortKey="Petcharapirat, P" uniqKey="Petcharapirat P">P Petcharapirat</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chi, Bh" uniqKey="Chi B">BH Chi</name></author><author><name sortKey="Mwango, A" uniqKey="Mwango A">A Mwango</name></author><author><name sortKey="Giganti, M" uniqKey="Giganti M">M Giganti</name></author><author><name sortKey="Mulenga, Lb" uniqKey="Mulenga L">LB Mulenga</name></author><author><name sortKey="Tambatamba Chapula, B" uniqKey="Tambatamba Chapula B">B Tambatamba-Chapula</name></author><author><name sortKey="Reid, Se" uniqKey="Reid S">SE Reid</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Burnett, Rj" uniqKey="Burnett R">RJ Burnett</name></author><author><name sortKey="Francois, G" uniqKey="Francois G">G Francois</name></author><author><name sortKey="Kew, Mc" uniqKey="Kew M">MC Kew</name></author><author><name sortKey="Leroux Roels, G" uniqKey="Leroux Roels G">G Leroux-Roels</name></author><author><name sortKey="Meheus, A" uniqKey="Meheus A">A Meheus</name></author><author><name sortKey="Hoosen, Aa" uniqKey="Hoosen A">AA Hoosen</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lukhwareni, A" uniqKey="Lukhwareni A">A Lukhwareni</name></author><author><name sortKey="Burnett, Rj" uniqKey="Burnett R">RJ Burnett</name></author><author><name sortKey="Selabe, Sg" uniqKey="Selabe S">SG Selabe</name></author><author><name sortKey="Mzileni, Mo" uniqKey="Mzileni M">MO Mzileni</name></author><author><name sortKey="Mphahlele, Mj" uniqKey="Mphahlele M">MJ Mphahlele</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Pang, T" uniqKey="Pang T">T Pang</name></author><author><name sortKey="Peeling, Rw" uniqKey="Peeling R">RW Peeling</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Yager, P" uniqKey="Yager P">P Yager</name></author><author><name sortKey="Domingo, Gj" uniqKey="Domingo G">GJ Domingo</name></author><author><name sortKey="Gerdes, J" uniqKey="Gerdes J">J Gerdes</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Wester, Cw" uniqKey="Wester C">CW Wester</name></author><author><name sortKey="Bussmann, H" uniqKey="Bussmann H">H Bussmann</name></author><author><name sortKey="Moyo, S" uniqKey="Moyo S">S Moyo</name></author><author><name sortKey="Avalos, A" uniqKey="Avalos A">A Avalos</name></author><author><name sortKey="Gaolathe, T" uniqKey="Gaolathe T">T Gaolathe</name></author><author><name sortKey="Ndwapi, N" uniqKey="Ndwapi N">N Ndwapi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Rouet, F" uniqKey="Rouet F">F Rouet</name></author><author><name sortKey="Chaix, Ml" uniqKey="Chaix M">ML Chaix</name></author><author><name sortKey="Inwoley, A" uniqKey="Inwoley A">A Inwoley</name></author><author><name sortKey="Msellati, P" uniqKey="Msellati P">P Msellati</name></author><author><name sortKey="Viho, I" uniqKey="Viho I">I Viho</name></author><author><name sortKey="Combe, P" uniqKey="Combe P">P Combe</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Shimelis, T" uniqKey="Shimelis T">T Shimelis</name></author><author><name sortKey="Torben, W" uniqKey="Torben W">W Torben</name></author><author><name sortKey="Medhin, G" uniqKey="Medhin G">G Medhin</name></author><author><name sortKey="Tebeje, M" uniqKey="Tebeje M">M Tebeje</name></author><author><name sortKey="Andualm, A" uniqKey="Andualm A">A Andualm</name></author><author><name sortKey="Demessie, F" uniqKey="Demessie F">F Demessie</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mboto, Ci" uniqKey="Mboto C">CI Mboto</name></author><author><name sortKey="Fielder, M" uniqKey="Fielder M">M Fielder</name></author><author><name sortKey="Davies Russell, A" uniqKey="Davies Russell A">A Davies-Russell</name></author><author><name sortKey="Jewell, Ap" uniqKey="Jewell A">AP Jewell</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Harania, Rs" uniqKey="Harania R">RS Harania</name></author><author><name sortKey="Karuru, J" uniqKey="Karuru J">J Karuru</name></author><author><name sortKey="Nelson, M" uniqKey="Nelson M">M Nelson</name></author><author><name sortKey="Stebbing, J" uniqKey="Stebbing J">J Stebbing</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Moore, E" uniqKey="Moore E">E Moore</name></author><author><name sortKey="Beadsworth, Mb" uniqKey="Beadsworth M">MB Beadsworth</name></author><author><name sortKey="Chaponda, M" uniqKey="Chaponda M">M Chaponda</name></author><author><name sortKey="Mhango, B" uniqKey="Mhango B">B Mhango</name></author><author><name sortKey="Faragher, B" uniqKey="Faragher B">B Faragher</name></author><author><name sortKey="Njala, J" uniqKey="Njala J">J Njala</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Nyirenda, M" uniqKey="Nyirenda M">M Nyirenda</name></author><author><name sortKey="Beadsworth, Mb" uniqKey="Beadsworth M">MB Beadsworth</name></author><author><name sortKey="Stephany, P" uniqKey="Stephany P">P Stephany</name></author><author><name sortKey="Hart, Ca" uniqKey="Hart C">CA Hart</name></author><author><name sortKey="Hart, Ij" uniqKey="Hart I">IJ Hart</name></author><author><name sortKey="Munthali, C" uniqKey="Munthali C">C Munthali</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ahmed, Sd" uniqKey="Ahmed S">SD Ahmed</name></author><author><name sortKey="Cuevas, Le" uniqKey="Cuevas L">LE Cuevas</name></author><author><name sortKey="Brabin, Bj" uniqKey="Brabin B">BJ Brabin</name></author><author><name sortKey="Kazembe, P" uniqKey="Kazembe P">P Kazembe</name></author><author><name sortKey="Broadhead, R" uniqKey="Broadhead R">R Broadhead</name></author><author><name sortKey="Verhoeff, Fh" uniqKey="Verhoeff F">FH Verhoeff</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Pirillo, Mf" uniqKey="Pirillo M">MF Pirillo</name></author><author><name sortKey="Bassani, L" uniqKey="Bassani L">L Bassani</name></author><author><name sortKey="Germinario, Ea" uniqKey="Germinario E">EA Germinario</name></author><author><name sortKey="Mancini, Mg" uniqKey="Mancini M">MG Mancini</name></author><author><name sortKey="Vyankandondera, J" uniqKey="Vyankandondera J">J Vyankandondera</name></author><author><name sortKey="Okong, P" uniqKey="Okong P">P Okong</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Di Bisceglie, Am" uniqKey="Di Bisceglie A">AM Di Bisceglie</name></author><author><name sortKey="Maskew, M" uniqKey="Maskew M">M Maskew</name></author><author><name sortKey="Schulze, D" uniqKey="Schulze D">D Schulze</name></author><author><name sortKey="Reyneke, A" uniqKey="Reyneke A">A Reyneke</name></author><author><name sortKey="Mcnamara, L" uniqKey="Mcnamara L">L McNamara</name></author><author><name sortKey="Firnhaber, C" uniqKey="Firnhaber C">C Firnhaber</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hoffmann, Cj" uniqKey="Hoffmann C">CJ Hoffmann</name></author><author><name sortKey="Charalambous, S" uniqKey="Charalambous S">S Charalambous</name></author><author><name sortKey="Martin, Dj" uniqKey="Martin D">DJ Martin</name></author><author><name sortKey="Innes, C" uniqKey="Innes C">C Innes</name></author><author><name sortKey="Churchyard, Gj" uniqKey="Churchyard G">GJ Churchyard</name></author><author><name sortKey="Chaisson, Re" uniqKey="Chaisson R">RE Chaisson</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kallestrup, P" uniqKey="Kallestrup P">P Kallestrup</name></author><author><name sortKey="Zinyama, R" uniqKey="Zinyama R">R Zinyama</name></author><author><name sortKey="Gomo, E" uniqKey="Gomo E">E Gomo</name></author><author><name sortKey="Dickmeiss, E" uniqKey="Dickmeiss E">E Dickmeiss</name></author><author><name sortKey="Platz, P" uniqKey="Platz P">P Platz</name></author><author><name sortKey="Gerstoft, J" uniqKey="Gerstoft J">J Gerstoft</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">J Glob Infect Dis</journal-id><journal-id journal-id-type="publisher-id">JGID</journal-id><journal-title-group><journal-title>Journal of Global Infectious Diseases</journal-title></journal-title-group><issn pub-type="ppub">0974-777X</issn><issn pub-type="epub">0974-8245</issn><publisher><publisher-name>Medknow Publications</publisher-name><publisher-loc>India</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">21887060</article-id><article-id pub-id-type="pmc">3162815</article-id><article-id pub-id-type="publisher-id">JGID-3-269</article-id><article-id pub-id-type="doi">10.4103/0974-777X.83534</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original Article</subject></subj-group></article-categories><title-group><article-title>HIV, Hepatitis B, and Hepatitis C in Zambia</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Kapembwa</surname><given-names>Kenneth C</given-names></name><xref ref-type="aff" rid="aff1">1</xref><xref ref-type="aff" rid="aff2">2</xref><xref ref-type="corresp" rid="cor1"></xref></contrib><contrib contrib-type="author"><name><surname>Goldman</surname><given-names>Jason D</given-names></name><xref ref-type="aff" rid="aff3">3</xref><xref ref-type="aff" rid="aff4">4</xref></contrib><contrib contrib-type="author"><name><surname>Lakhi</surname><given-names>Shabir</given-names></name><xref ref-type="aff" rid="aff1">1</xref><xref ref-type="aff" rid="aff2">2</xref></contrib><contrib contrib-type="author"><name><surname>Banda</surname><given-names>Yolan</given-names></name><xref ref-type="aff" rid="aff4">4</xref></contrib><contrib contrib-type="author"><name><surname>Bowa</surname><given-names>Kasonde</given-names></name><xref ref-type="aff" rid="aff5">5</xref></contrib><contrib contrib-type="author"><name><surname>Vermund</surname><given-names>Sten H</given-names></name><xref ref-type="aff" rid="aff4">4</xref><xref ref-type="aff" rid="aff6">6</xref></contrib><contrib contrib-type="author"><name><surname>Mulenga</surname><given-names>Joseph</given-names></name><xref ref-type="aff" rid="aff7">7</xref></contrib><contrib contrib-type="author"><name><surname>Chama</surname><given-names>David</given-names></name><xref ref-type="aff" rid="aff7">7</xref></contrib><contrib contrib-type="author"><name><surname>Chi</surname><given-names>Benjamin H</given-names></name><xref ref-type="aff" rid="aff4">4</xref><xref ref-type="aff" rid="aff8">8</xref></contrib></contrib-group><aff id="aff1"><label>1</label><italic>Department of Internal Medicine, School of Medicine, University of Zambia, Lusaka, Zambia</italic></aff><aff id="aff2"><label>2</label><italic>Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia</italic></aff><aff id="aff3"><label>3</label><italic>Department of Medicine, School of Medicine, University of Washington, Seattle, WA</italic></aff><aff id="aff4"><label>4</label><italic>Centre for Infectious Disease Research in Zambia, Lusaka, Zambia</italic></aff><aff id="aff5"><label>5</label><italic>Department of Surgery, School of Medicine, University Teaching Hospital, Lusaka, Zambia</italic></aff><aff id="aff6"><label>6</label><italic>Institute of Global Health and Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN</italic></aff><aff id="aff7"><label>7</label><italic>Zambia National Blood Transfusion Service, Lusaka, Zambia</italic></aff><aff id="aff8"><label>8</label><italic>Department of Obstetrics and Gynecology, School of Medicine, University of Alabama, Birmingham, AL, USA</italic></aff><author-notes><corresp id="cor1"><bold>Address for correspondence:</bold> Dr. Kenneth Kapembwa, E-mail: <email xlink:href="kkapembwa@yahoo.com">kkapembwa@yahoo.com</email></corresp></author-notes><pub-date pub-type="ppub"><season>Jul-Sep</season><year>2011</year></pub-date><volume>3</volume><issue>3</issue><fpage>269</fpage><lpage>274</lpage><permissions><copyright-statement>© Journal of Global Infectious Diseases</copyright-statement><copyright-year>2011</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc-sa/3.0"><license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><abstract><sec id="st1"><title>Objectives</title><p>Epidemiologic data of HIV and viral hepatitis coinfection are needed in sub-Saharan Africa to guide health policy for hepatitis screening and optimized antiretroviral therapy (ART).</p></sec><sec id="st2"><title>Materials and Methods:</title><p>We screened 323 HIV-infected, ART-eligible adults for hepatitis B surface antigen (HBsAg) and hepatitis C antibody (HCV Ab) at a tertiary hospital in Lusaka, Zambia. We collected basic demographic, medical, and laboratory data to determine predictors for coinfection.</p></sec><sec id="st3"><title>Results:</title><p>Of 323 enrolled patients, 32 (9.9%; 95% CI=6.7–13.2%) were HBsAg positive, while 4 (1.2%; 95% CI=0.03–2.4%) were HCV Ab positive. Patients with hepatitis B coinfection were more likely to be <40 years (84.4% vs. 61.4%; <italic>P</italic>=0.01) when compared to those who were not coinfected. Patients with active hepatitis B were more likely to have mild to moderately elevated AST/ALT (40–199 IU/L, 15.8% vs. 5.4%; <italic>P</italic>=0.003). Highly elevated liver enzymes (>200 IU/L) was uncommon and did not differ between the two groups (3.4% vs. 2.3%; <italic>P</italic>=0.5). We were unable to determine predictors of hepatitis C infection due to the low prevalence of disease.</p></sec><sec id="st4"><title>Conclusions:</title><p>HIV and hepatitis B coinfection was common among patients initiating ART at this tertiary care facility. Routine screening for hepatitis B should be considered for HIV-infected persons in southern Africa.</p></sec></abstract><kwd-group><kwd>Africa</kwd><kwd>Hepatitis B</kwd><kwd>Hepatitis C</kwd><kwd>HIV</kwd><kwd>Prevalence</kwd><kwd>Zambia</kwd></kwd-group></article-meta></front><body><sec sec-type="intro" id="sec1-1"><title>INTRODUCTION</title><p>Since 2004, the Zambian government's program for antiretroviral therapy (ART) has expanded rapidly in the public sector.[<xref ref-type="bibr" rid="ref1">1</xref><xref ref-type="bibr" rid="ref2">2</xref>] Because of severe resource constraints, however, the routine screening for hepatitis B virus (HBV) and hepatitis C virus (HCV) has not been incorporated into the country's HIV treatment guidelines. Understanding the extent of these dual epidemics is critical to the optimization of HIV treatment. Several antiretroviral drugs – most notably nevirapine and lopinavir – are associated with liver failure among patients with HBV or HCV infection.[<xref ref-type="bibr" rid="ref3">3</xref>–<xref ref-type="bibr" rid="ref7">7</xref>] Conversely, tenofovir and lamivudine have been shown to inhibit HBV replication and could be used to improve long-term clinical outcomes.</p><p>Studies of HBV surface antigen (HBsAg) prevalence among HIV-infected adults have provided varying estimates in Zambia. In a 1996 survey, Oshitani and colleagues detected HBsAg in the serum samples of 24 of 340 (7.1%) HIV-infected pregnant women.[<xref ref-type="bibr" rid="ref8">8</xref>] In 2002, Kasolo <italic>et al</italic>. estimated HBsAg seropositivity in 31.3% among HIV-infected adults hospitalized at a tertiary care institution.[<xref ref-type="bibr" rid="ref9">9</xref>] To our knowledge, there are no studies examining co-infection rates among adults starting ART in a primary care setting, nor are there published data on HCV-HIV coinfection prevalence in Zambia.</p></sec><sec sec-type="materials|methods" id="sec1-2"><title>MATERIALS AND METHODS</title><p>We conducted a cross-sectional study of adults seeking HIV care and treatment at the University Teaching Hospital (UTH), a 2500-bed tertiary care center in Lusaka. The UTH Department of Internal Medicine manages one of the country's oldest ART programs, founded in 2001 by the Ministry of Health.[<xref ref-type="bibr" rid="ref10">10</xref>] Individuals who present to the clinic are screened for ART eligibility based on the Zambian national guidelines that are similar to those of the World Health Organization (WHO): CD4+ cell count <200 cells/μL, or WHO disease stage IV, or CD4+ cell count <350 cells/μL and WHO disease stage III.[<xref ref-type="bibr" rid="ref11">11</xref>] Unlike the neighboring primary care centers of the Lusaka district that rely heavily on mid-level clinicians,[<xref ref-type="bibr" rid="ref12">12</xref>] care at UTH is provided by physicians.</p><p>We recruited adolescents and adults >16 years of age with confirmed HIV infection who were identified as ART eligible. Trained study staff approached potential candidates, described study procedures, and obtained informed consent for the hepatitis survey. Only adults who were ART naïve were considered, unless the previous ART use was deliberately transient, as with postexposure prophylaxis or perinatal HIV prevention. All participants were asked to complete a 28-question survey, administered in the language of their choice: English, Nyanja, or Bemba. Questions covered demographic characteristics, medical history, socioeconomic history, and risk factors for hepatitis B and/or C acquisition.</p><p>Blood specimens were drawn for viral hepatitis screening. We used the enzyme immunoassays to detect HBsAg for acute HBV (Axsym HBsAg™ , version 2; Abbott Max-Planck, Wiesbaden, Germany) and anti-HCV antibodies for HCV infection (Axsym HCV™ , version 3; Abbott Max-Planck, Wiesbaden, Germany). Baseline alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were analyzed using an automated chemistry analyzer (Cobas Integra 400™ ; Roche, Mannheim, Germany). Liver enzyme elevation was based on guidelines set forth by the Division of AIDS, U.S. National Institutes of Health.[<xref ref-type="bibr" rid="ref13">13</xref>] We graded liver enzyme elevations according to the highest results between ALT or AST as follows: ALT and/or AST of 50–100 U/L mild elevation; 101-200 U/L moderate elevation; >200 U/L severe elevations.</p><p>To compare categorical variables, we used Pearson's chi-square test and Fisher's exact test, as appropriate. For continuous variables, statistical comparisons were made using Wilcoxon's rank sum tests. Our sample size was based on an estimated HBV prevalence of 31%,[<xref ref-type="bibr" rid="ref9">9</xref>] with a precision ±5%. All analyses were performed using SAS™ , version 9.1.3 (SAS Institute, Cary, NC, USA). This analysis was approved by the Institutional Review Boards of the University of Zambia (Lusaka, Zambia) and the University of Alabama at Birmingham (Birmingham, AL, USA).</p></sec><sec sec-type="results" id="sec1-3"><title>RESULTS</title><p>From December 12, 2007 to June 13, 2008, we enrolled 323 ART-naïve adolescents and adults >16 years of age into our study. The median age was 37 years (IQR=32, 44); median CD4+ cell count was 118 cells/μL (IQR=59, 199); and 174 (54%) were women. Of the 323 participants, 32 (9.9%; 95% confidence interval [CI]: 6.7–13.2%) were HBsAg positive while four (1.2%; 95% CI: 0.03–2.4%) were anti-HCV antibody seropositive. No one was coinfected with hepatitis B and C.</p><p>Patients with active HBV and HIV coinfection were more likely to be <40 years of age (84.4%) when compared to those who were not coinfected (63.9%; <italic>P</italic>=0.02). No differences in prevalence were noted according to sex, baseline WHO stage, or CD4+ cell count. A history of blood transfusion, that of tattooing, reported sexual partners in the past year, and past history of sexually transmitted infections were also not associated significantly with HBV [<xref ref-type="table" rid="T1">Table 1</xref>]. Mild to moderately elevated liver transaminases (AST or ALT) were more likely to be observed among patients with HBV coinfection (<italic>P</italic>=0.003). A severe elevation of liver enzymes (≥200 IU/L) was uncommon in this population (7 of 290; 2.4%) and similar between the HIV/HBV coinfected and non-co-infected groups (3.4% vs. 2.3%; <italic>P</italic>=0.5). No statistically significant predictors of hepatitis C infection were identified, though our statistical power to observe differences was very low with only four HCV infected persons (data not shown).</p><table-wrap id="T1" position="float"><label>Table 1</label><caption><p>Univariate predictors of active hepatitis B infection among HIV-infected adults eligible for antiretroviral therapy</p></caption><graphic xlink:href="JGID-3-269-g001"></graphic></table-wrap></sec><sec sec-type="discussion" id="sec1-4"><title>DISCUSSION</title><p>As the HIV epidemic in Zambia moves forward in the ART era, new data on hepatitis coinfection are clearly needed to guide health policy. In this cross-sectional study, we found that active HBV coinfection (HBsAg seropositivity) occurred in 9.9% of ART-naïve HIV-infected patients. In contrast, HCV occurred in only 1.2% of HIV-infected persons, a finding consistent with the primarily heterosexual transmission of HIV and low intravenous drug use in our setting.</p><p>Our estimate of HBV prevalence was lower than the 31% reported in 2003 at UTH, a figure upon which our sample size had been based. In that study, Kasolo and colleagues had targeted hospitalized patients and this likely contributed to the unusually high prevalence observed among HIV-positive adults.[<xref ref-type="bibr" rid="ref14">14</xref>] Our results are more consistent with studies in South Africa (4.8%),[<xref ref-type="bibr" rid="ref15">15</xref>] Nigeria (11.9%),[<xref ref-type="bibr" rid="ref16">16</xref>] Senegal (16.8%),[<xref ref-type="bibr" rid="ref17">17</xref>] and Tanzania (17.3%)[<xref ref-type="bibr" rid="ref18">18</xref>] that targeted HIV-eligible patients in an outpatient setting. It also approximated disease prevalence among HIV-infected pregnant women in Zambia (7.1%).[<xref ref-type="bibr" rid="ref8">8</xref>]</p><p>With the initiation of antiretroviral therapy and subsequent immune reconstitution, a concern is a paradoxical exacerbation of inflammatory-related pathology in persons with HBV who may not know their status. In our HIV-infected population, patients with HBV coinfection were more likely to have moderately elevated ALT but not severely elevated aminotransferase levels. Prior studies have found that among HBV-infected individuals, HIV coinfection is actually associated with lower ALT levels but higher risk of progression to cirrhosis.[<xref ref-type="bibr" rid="ref19">19</xref><xref ref-type="bibr" rid="ref20">20</xref>] This finding may be related to the impairment of immunity in advanced HIV, which – despite higher rates of HBV replication – results in less inflammation and necrosis. Indeed, in HIV-infected patients, HBV coinfection is an independent predictor for cirrhosis,[<xref ref-type="bibr" rid="ref21">21</xref>] hepatocellular carcinoma,[<xref ref-type="bibr" rid="ref22">22</xref>] and mortality.[<xref ref-type="bibr" rid="ref23">23</xref>]</p><p>To prevent this excess morbidity and mortality associated with HIV/HBV coinfection, treatment guidelines in upper-income nations recommend screening all HIV-infected adults for viral hepatitis.[<xref ref-type="bibr" rid="ref24">24</xref>] Recently updated guidelines from the WHO recommend that all patients who require treatment for HBV coinfection initiate ART, regardless of the CD4 count or WHO clinical stage.[<xref ref-type="bibr" rid="ref25">25</xref>] Such an approach has also been adopted by the Zambian Ministry of Health.[<xref ref-type="bibr" rid="ref26">26</xref>] HBsAg is now recommended as part of eligibility screening for ART. For HBsAg-positive individuals with CD4 counts higher than 350 cells/μL, ART can be initiated if liver transaminases are elevated or if HBsAg positivity remains persistent for at least 6 months. Although this represents an important step forward in health policy, the limited availability of hepatitis B screening countrywide – particularly in rural areas – represents a significant challenge to its implementation.</p><p>With knowledge of HBV-HIV coinfection, ART regimens could be tailored to treat both conditions. Screening information could also be helpful early in the course of ART, to better understand the development of the immune reconstitution inflammatory syndrome. Validated algorithms to triage high-risk patients for HBV screening could help improve the cost-efficiency of screening programs, but our data suggest that there may be few well-performing demographic or medical predictors. For example, 16 out of 29 (55%) of HBV coinfected patients would be missed if mildly elevated liver enzymes alone were used to triage screening. In contrast with HBV screening, the low disease prevalence of HCV-HIV coinfection suggests that universal screening for HCV is not likely to be cost-effective in our setting.</p><p>Several antiretroviral drugs for HIV treatment are known to inhibit HBV replication, including lamivudine, emtricitabine, and tenofovir.[<xref ref-type="bibr" rid="ref27">27</xref><xref ref-type="bibr" rid="ref28">28</xref>] As tenofovir-lamivudine and tenofovir–emtricitabine “backbones” gain a widespread use in Africa – as they have in Zambia[<xref ref-type="bibr" rid="ref29">29</xref>] – a large proportion of co-infected patients will receive “empiric” treatment for HBV regardless of formal diagnosis. In this scenario, the initial ART regimen could be used as a criterion to triage HBV screening, so that testing is performed when tenofovir-based regimens are contraindicated or unavailable. While this approach considers only one benefit of HBV screening, such strategies should be considered in settings where universal hepatitis screening is not feasible.</p><p>Control strategies for HBV in Zambia have focused on blood bank screening and childhood vaccination. HBV and HCV screening is now universal in transfusion centers across the country, based on guidance from the Ministry of Health. Zambia has also incorporated HBV vaccination into the routine childhood schedule in 2005, and the WHO–UNICEF estimated a coverage of 80% in 2009.[<xref ref-type="bibr" rid="ref30">30</xref>] Childhood vaccination is especially important given the presumed mode of HBV transmission as horizontal (from family or other close contacts) during early childhood.[<xref ref-type="bibr" rid="ref31">31</xref>]</p><p>Although rates of HIV-HCV coinfection have not been previously published for Zambia, our estimates for anti-HCV antibody positivity were similar to numerous regional surveys conducted over the past decade [<xref ref-type="table" rid="T2">Table 2</xref>]. Our findings are consistent with the largely heterosexual epidemic, with very few HIV infections caused via injection drug use, tattooing or razors, or medical misuse of contaminated needles (the most efficient means of HCV transmission). The wide range of prevalence estimates seen across sub-Saharan Africa demonstrates the need for ongoing surveillance activities.</p><table-wrap id="T2" position="float"><label>Table 2</label><caption><p>Surveys of hepatitis B virus surface antigen (HBsAg) and hepatitis C antibody (HCV Ab) prevalence in HIV-infected persons conducted in Zambia and neighboring sub-Saharan Africa countries, 1996-2011</p></caption><graphic xlink:href="JGID-3-269-g002"></graphic></table-wrap><p>We note several limitations to our study. By only testing for a single marker of HBV infection, we were unable to fully describe the epidemiology of the disease in our setting. We cannot comment on lifetime HBV infection rates as we did not measure core or surface antibodies. The inclusion of other serologic markers could also have allowed us to report early or “occult” infections,[<xref ref-type="bibr" rid="ref32">32</xref>] which may have implications in HIV/HBV coinfected patents as the immune system reconstitutes. Our surveillance of HBV prevalence resulted in far fewer cases than anticipated and limited our ability to investigate independent predictors of coinfection.</p></sec><sec sec-type="conclusion" id="sec1-5"><title>CONCLUSION</title><p>Active HBV coinfection was diagnosed among nearly 10% of HIV-infected adults eligible for ART at a tertiary care center in Lusaka, Zambia. In contrast, coinfection with HCV was uncommon at approximately 1%. We did not observe any clinically useful predictors for viral hepatitis, suggesting that routine screening should be considered in settings with appropriate resources. Lower cost screening modalities for viral hepatitis are an urgent need to upgrade HIV care in resource-limited settings.[<xref ref-type="bibr" rid="ref33">33</xref><xref ref-type="bibr" rid="ref34">34</xref>] Antiretroviral drugs with anti-HBV properties could be used preferentially in coinfected persons.</p></sec></body><back><fn-group><fn fn-type="supported-by"><p><bold>Source of Support:</bold> Nil.</p></fn><fn fn-type="conflict"><p><bold>Conflict of Interest:</bold> None declared.</p></fn></fn-group><ref-list><title>REFERENCES</title><ref id="ref1"><label>1</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Stringer</surname><given-names>JS</given-names></name><name><surname>Zulu</surname><given-names>I</given-names></name><name><surname>Levy</surname><given-names>J</given-names></name><name><surname>Stringer</surname><given-names>EM</given-names></name><name><surname>Mwango</surname><given-names>A</given-names></name><name><surname>Chi</surname><given-names>BH</given-names></name><etal></etal></person-group><article-title>Rapid scale-up of antiretroviral therapy at primary care sites in Zambia: Feasibility and early outcomes</article-title><source>JAMA</source><year>2006</year><volume>296</volume><fpage>782</fpage><lpage>93</lpage><pub-id pub-id-type="pmid">16905784</pub-id></element-citation></ref><ref id="ref2"><label>2</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Bolton-Moore</surname><given-names>C</given-names></name><name><surname>Mubiana-Mbewe</surname><given-names>M</given-names></name><name><surname>Cantrell</surname><given-names>RA</given-names></name><name><surname>Chintu</surname><given-names>N</given-names></name><name><surname>Stringer</surname><given-names>EM</given-names></name><name><surname>Chi</surname><given-names>BH</given-names></name><etal></etal></person-group><article-title>Clinical outcomes and CD4 cell response in children receiving antiretroviral therapy at primary health care facilities in Zambia</article-title><source>JAMA</source><year>2007</year><volume>298</volume><fpage>1888</fpage><lpage>99</lpage><pub-id pub-id-type="pmid">17954540</pub-id></element-citation></ref><ref id="ref3"><label>3</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Sulkowski</surname><given-names>MS</given-names></name><name><surname>Thomas</surname><given-names>DL</given-names></name><name><surname>Mehta</surname><given-names>SH</given-names></name><name><surname>Chaisson</surname><given-names>RE</given-names></name><name><surname>Moore</surname><given-names>RD</given-names></name></person-group><article-title>Hepatotoxicity associated with nevirapine or efavirenz-containing antiretroviral therapy: Role of hepatitis C and B infections</article-title><source>Hepatology</source><year>2002</year><volume>35</volume><fpage>182</fpage><lpage>9</lpage><pub-id pub-id-type="pmid">11786975</pub-id></element-citation></ref><ref id="ref4"><label>4</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Martinez</surname><given-names>E</given-names></name><name><surname>Blanco</surname><given-names>JL</given-names></name><name><surname>Arnaiz</surname><given-names>JA</given-names></name><name><surname>Perez-Cuevas</surname><given-names>JB</given-names></name><name><surname>Mocroft</surname><given-names>A</given-names></name><name><surname>Cruceta</surname><given-names>A</given-names></name><etal></etal></person-group><article-title>Hepatotoxicity in HIV-1-infected patients receiving nevirapine-containing antiretroviral therapy</article-title><source>AIDS</source><year>2001</year><volume>15</volume><fpage>1261</fpage><lpage>8</lpage><pub-id pub-id-type="pmid">11426070</pub-id></element-citation></ref><ref id="ref5"><label>5</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>de Maat</surname><given-names>MM</given-names></name><name><surname>ter Heine</surname><given-names>R</given-names></name><name><surname>van Gorp</surname><given-names>EC</given-names></name><name><surname>Mulder</surname><given-names>JW</given-names></name><name><surname>Mairuhu</surname><given-names>AT</given-names></name><name><surname>Beijnen</surname><given-names>JH</given-names></name></person-group><article-title>Case series of acute hepatitis in a non-selected group of HIV-infected patients on nevirapine-containing antiretroviral treatment</article-title><source>AIDS</source><year>2003</year><volume>17</volume><fpage>2209</fpage><lpage>14</lpage><pub-id pub-id-type="pmid">14523278</pub-id></element-citation></ref><ref id="ref6"><label>6</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Aceti</surname><given-names>A</given-names></name><name><surname>Pasquazzi</surname><given-names>C</given-names></name><name><surname>Zechini</surname><given-names>B</given-names></name><name><surname>De Bac</surname><given-names>C</given-names></name></person-group><article-title>Hepatotoxicity development during antiretroviral therapy containing protease inhibitors in patients with HIV: The role of hepatitis B and C virus infection</article-title><source>J Acquir Immune Defic Syndr</source><year>2002</year><volume>29</volume><fpage>41</fpage><lpage>8</lpage><pub-id pub-id-type="pmid">11782588</pub-id></element-citation></ref><ref id="ref7"><label>7</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Arribas</surname><given-names>JR</given-names></name><name><surname>Ibanez</surname><given-names>C</given-names></name><name><surname>Ruiz-Antoran</surname><given-names>B</given-names></name><name><surname>Pena</surname><given-names>JM</given-names></name><name><surname>Esteban-Calvo</surname><given-names>C</given-names></name><name><surname>Frias</surname><given-names>J</given-names></name><etal></etal></person-group><article-title>Acute hepatitis in HIV-infected patients during ritonavir treatment</article-title><source>AIDS</source><year>1998</year><volume>12</volume><fpage>1722</fpage><lpage>4</lpage><pub-id pub-id-type="pmid">9764797</pub-id></element-citation></ref><ref id="ref8"><label>8</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Oshitani</surname><given-names>H</given-names></name><name><surname>Kasolo</surname><given-names>FC</given-names></name><name><surname>Mpabalwani</surname><given-names>M</given-names></name><name><surname>Mizuta</surname><given-names>K</given-names></name><name><surname>Luo</surname><given-names>NP</given-names></name><name><surname>Suzuki</surname><given-names>H</given-names></name><etal></etal></person-group><article-title>Prevalence of hepatitis B antigens in human immunodeficiency virus type 1 seropositive and seronegative pregnant women in Zambia</article-title><source>Trans R Soc Trop Med Hyg</source><year>1996</year><volume>90</volume><fpage>235</fpage><lpage>6</lpage><pub-id pub-id-type="pmid">8758060</pub-id></element-citation></ref><ref id="ref9"><label>9</label><element-citation publication-type="book"><person-group person-group-type="author"><name><surname>Kasolo</surname><given-names>F</given-names></name><name><surname>Sakala</surname><given-names>I</given-names></name><name><surname>Baboo</surname><given-names>K</given-names></name></person-group><article-title>Hepatitis B virus infection in human immunodeficiency virus seropositive patients at the University Teaching Hospital, Lusaka, Zambia: Interrelationship</article-title><year>2003</year><publisher-loc>Paris, France</publisher-loc><publisher-name>Conference on HIV Pathogenesis and Treatment</publisher-name><comment>[Abstract no. 963]. 2nd</comment></element-citation></ref><ref id="ref10"><label>10</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Mwaba</surname><given-names>P</given-names></name><name><surname>Zulu</surname><given-names>I</given-names></name><name><surname>Kafula</surname><given-names>T</given-names></name><name><surname>Chisembele</surname><given-names>M</given-names></name><name><surname>Mtonga</surname><given-names>V</given-names></name><name><surname>Kankasa</surname><given-names>C</given-names></name><etal></etal></person-group><article-title>The GRZ ARV Pilot Program: The UTH Experience</article-title><source>Zambia Med J</source><year>2004</year><volume>6</volume><fpage>118</fpage><lpage>20</lpage></element-citation></ref><ref id="ref11"><label>11</label><element-citation publication-type="book"><article-title>World Health Organization</article-title><source>Antiretroviral therapy for HIV infection in adults and adolescents in resource-limited settings</source><year>2006</year><publisher-loc>Geneva</publisher-loc><publisher-name>towards universal access</publisher-name></element-citation></ref><ref id="ref12"><label>12</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Morris</surname><given-names>MB</given-names></name><name><surname>Chapula</surname><given-names>BT</given-names></name><name><surname>Chi</surname><given-names>BH</given-names></name><name><surname>Mwango</surname><given-names>A</given-names></name><name><surname>Chi</surname><given-names>HF</given-names></name><name><surname>Mwanza</surname><given-names>J</given-names></name><etal></etal></person-group><article-title>Use of task-shifting to rapidly scale-up HIV treatment services: Experiences from Lusaka, Zambia</article-title><source>BMC Health Serv Res</source><year>2009</year><volume>9</volume><fpage>5</fpage><pub-id pub-id-type="pmid">19134202</pub-id></element-citation></ref><ref id="ref13"><label>13</label><element-citation publication-type="book"><article-title>AIDS Clinical Trials Group</article-title><source>Table of grading severity of adult adverse experiences</source><year>2004</year><publisher-loc>Rockville, MD</publisher-loc><publisher-name>Division of AIDS, National Institutes of Allergy and Infectious Diseases</publisher-name></element-citation></ref><ref id="ref14"><label>14</label><element-citation publication-type="book"><article-title>Hepatitis B virus infection in human innumodeficiency virus seropositive patients at the University Teaching Hospital, Lusaka, Zambia: Interrelationship</article-title><year>2003</year><publisher-loc>Paris, France</publisher-loc><publisher-name>2nd IAS Conference on HIV Pathogenesis and Treatment</publisher-name><comment>[abstract no. 963]</comment></element-citation></ref><ref id="ref15"><label>15</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Firnhaber</surname><given-names>C</given-names></name><name><surname>Reyneke</surname><given-names>A</given-names></name><name><surname>Schulze</surname><given-names>D</given-names></name><name><surname>Malope</surname><given-names>B</given-names></name><name><surname>Maskew</surname><given-names>M</given-names></name><name><surname>MacPhail</surname><given-names>P</given-names></name><etal></etal></person-group><article-title>The prevalence of hepatitis B co-infection in a South African urban government HIV clinic</article-title><source>S Afr Med J</source><year>2008</year><volume>98</volume><fpage>541</fpage><lpage>4</lpage><pub-id pub-id-type="pmid">18785395</pub-id></element-citation></ref><ref id="ref16"><label>16</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Otegbayo</surname><given-names>JA</given-names></name><name><surname>Taiwo</surname><given-names>BO</given-names></name><name><surname>Akingbola</surname><given-names>TS</given-names></name><name><surname>Odaibo</surname><given-names>GN</given-names></name><name><surname>Adedapo</surname><given-names>KS</given-names></name><name><surname>Penugonda</surname><given-names>S</given-names></name><etal></etal></person-group><article-title>Prevalence of hepatitis B and C seropositivity in a Nigerian cohort of HIV-infected patients</article-title><source>Ann Hepatol</source><year>2008</year><volume>7</volume><fpage>152</fpage><lpage>6</lpage><pub-id pub-id-type="pmid">18626434</pub-id></element-citation></ref><ref id="ref17"><label>17</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Diop-Ndiaye</surname><given-names>H</given-names></name><name><surname>Toure-Kane</surname><given-names>C</given-names></name><name><surname>Etard</surname><given-names>JF</given-names></name><name><surname>Lo</surname><given-names>G</given-names></name><name><surname>Diaw</surname><given-names>P</given-names></name><name><surname>Ngom-Gueye</surname><given-names>NF</given-names></name><etal></etal></person-group><article-title>Hepatitis B, C seroprevalence and delta viruses in HIV-1 Senegalese patients at HAART initiation (retrospective study)</article-title><source>J Med Virol</source><year>2008</year><volume>80</volume><fpage>1332</fpage><lpage>6</lpage><pub-id pub-id-type="pmid">18551596</pub-id></element-citation></ref><ref id="ref18"><label>18</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Nagu</surname><given-names>TJ</given-names></name><name><surname>Bakari</surname><given-names>M</given-names></name><name><surname>Matee</surname><given-names>M</given-names></name></person-group><article-title>Hepatitis A, B and C viral co-infections among HIV-infected adults presenting for care and treatment at Muhimbili National Hospital in Dar es Salaam, Tanzania</article-title><source>BMC Public Health</source><year>2008</year><volume>8</volume><fpage>416</fpage><pub-id pub-id-type="pmid">19099553</pub-id></element-citation></ref><ref id="ref19"><label>19</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Hadler</surname><given-names>SC</given-names></name><name><surname>Judson</surname><given-names>FN</given-names></name><name><surname>O’Malley</surname><given-names>PM</given-names></name><name><surname>Altman</surname><given-names>NL</given-names></name><name><surname>Penley</surname><given-names>K</given-names></name><name><surname>Buchbinder</surname><given-names>S</given-names></name><etal></etal></person-group><article-title>Outcome of hepatitis B virus infection in homosexual men and its relation to prior human immunodeficiency virus infection</article-title><source>J Infect Dis</source><year>1991</year><volume>163</volume><fpage>454</fpage><lpage>9</lpage><pub-id pub-id-type="pmid">1825315</pub-id></element-citation></ref><ref id="ref20"><label>20</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Colin</surname><given-names>JF</given-names></name><name><surname>Cazals-Hatem</surname><given-names>D</given-names></name><name><surname>Loriot</surname><given-names>MA</given-names></name><name><surname>Martinot-Peignoux</surname><given-names>M</given-names></name><name><surname>Pham</surname><given-names>BN</given-names></name><name><surname>Auperin</surname><given-names>A</given-names></name><etal></etal></person-group><article-title>Influence of human immunodeficiency virus infection on chronic hepatitis B in homosexual men</article-title><source>Hepatology</source><year>1999</year><volume>29</volume><fpage>1306</fpage><lpage>10</lpage><pub-id pub-id-type="pmid">10094979</pub-id></element-citation></ref><ref id="ref21"><label>21</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Thio</surname><given-names>CL</given-names></name><name><surname>Seaberg</surname><given-names>EC</given-names></name><name><surname>Skolasky</surname><given-names>R</given-names><suffix>Jr</suffix></name><name><surname>Phair</surname><given-names>J</given-names></name><name><surname>Visscher</surname><given-names>B</given-names></name><name><surname>Munoz</surname><given-names>A</given-names></name><etal></etal></person-group><article-title>HIV-1, hepatitis B virus, and risk of liver-related mortality in the Multicenter Cohort Study (MACS)</article-title><source>Lancet</source><year>2002</year><volume>360</volume><fpage>1921</fpage><lpage>6</lpage><pub-id pub-id-type="pmid">12493258</pub-id></element-citation></ref><ref id="ref22"><label>22</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Puoti</surname><given-names>M</given-names></name><name><surname>Bruno</surname><given-names>R</given-names></name><name><surname>Soriano</surname><given-names>V</given-names></name><name><surname>Donato</surname><given-names>F</given-names></name><name><surname>Gaeta</surname><given-names>GB</given-names></name><name><surname>Quinzan</surname><given-names>GP</given-names></name><etal></etal></person-group><article-title>Hepatocellular carcinoma in HIV-infected patients: Epidemiological features, clinical presentation and outcome</article-title><source>AIDS</source><year>2004</year><volume>18</volume><fpage>2285</fpage><lpage>93</lpage><pub-id pub-id-type="pmid">15577541</pub-id></element-citation></ref><ref id="ref23"><label>23</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Nikolopoulos</surname><given-names>GK</given-names></name><name><surname>Paraskevis</surname><given-names>D</given-names></name><name><surname>Hatzitheodorou</surname><given-names>E</given-names></name><name><surname>Moschidis</surname><given-names>Z</given-names></name><name><surname>Sypsa</surname><given-names>V</given-names></name><name><surname>Zavitsanos</surname><given-names>X</given-names></name><etal></etal></person-group><article-title>Impact of hepatitis B virus infection on the progression of AIDS and mortality in HIV-infected individuals: A cohort study and meta-analysis</article-title><source>Clin Infect Dis</source><year>2009</year><volume>48</volume><fpage>1763</fpage><lpage>71</lpage><pub-id pub-id-type="pmid">19435436</pub-id></element-citation></ref><ref id="ref24"><label>24</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Kaplan</surname><given-names>JE</given-names></name><name><surname>Benson</surname><given-names>C</given-names></name><name><surname>Holmes</surname><given-names>KH</given-names></name><name><surname>Brooks</surname><given-names>JT</given-names></name><name><surname>Pau</surname><given-names>A</given-names></name><name><surname>Masur</surname><given-names>H</given-names></name></person-group><article-title>Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: Recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America</article-title><source>MMWR Recomm Rep</source><year>2009</year><volume>58</volume><fpage>1</fpage><lpage>207</lpage></element-citation></ref><ref id="ref25"><label>25</label><element-citation publication-type="book"><article-title>World Health Organization</article-title><source>Rapid advice: Antiretroviral therapy for HIV infection for adults and adolescents, November 2009</source><year>2009</year><publisher-loc>Geneva</publisher-loc><publisher-name>WHO Press</publisher-name></element-citation></ref><ref id="ref26"><label>26</label><element-citation publication-type="book"><article-title>Zambian Ministry of Health</article-title><source>Adult and adolescent antiretroviral therapy protocols</source><year>2010</year><publisher-loc>Lusaka, Zambia</publisher-loc><publisher-name>Printech Press</publisher-name></element-citation></ref><ref id="ref27"><label>27</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Matthews</surname><given-names>GV</given-names></name><name><surname>Seaberg</surname><given-names>E</given-names></name><name><surname>Dore</surname><given-names>GJ</given-names></name><name><surname>Bowden</surname><given-names>S</given-names></name><name><surname>Lewin</surname><given-names>SR</given-names></name><name><surname>Sasadeusz</surname><given-names>J</given-names></name><etal></etal></person-group><article-title>Combination HBV therapy is linked to greater HBV DNA suppression in a cohort of lamivudine-experienced HIV/HBV coinfected individuals</article-title><source>AIDS</source><year>2009</year><volume>23</volume><fpage>1707</fpage><lpage>15</lpage><pub-id pub-id-type="pmid">19584701</pub-id></element-citation></ref><ref id="ref28"><label>28</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Matthews</surname><given-names>GV</given-names></name><name><surname>Avihingsanon</surname><given-names>A</given-names></name><name><surname>Lewin</surname><given-names>SR</given-names></name><name><surname>Amin</surname><given-names>J</given-names></name><name><surname>Rerknimitr</surname><given-names>R</given-names></name><name><surname>Petcharapirat</surname><given-names>P</given-names></name><etal></etal></person-group><article-title>A randomized trial of combination hepatitis B therapy in HIV/HBV coinfected antiretroviral naive individuals in Thailand</article-title><source>Hepatology</source><year>2008</year><volume>48</volume><fpage>1062</fpage><lpage>9</lpage><pub-id pub-id-type="pmid">18697216</pub-id></element-citation></ref><ref id="ref29"><label>29</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Chi</surname><given-names>BH</given-names></name><name><surname>Mwango</surname><given-names>A</given-names></name><name><surname>Giganti</surname><given-names>M</given-names></name><name><surname>Mulenga</surname><given-names>LB</given-names></name><name><surname>Tambatamba-Chapula</surname><given-names>B</given-names></name><name><surname>Reid</surname><given-names>SE</given-names></name><etal></etal></person-group><article-title>Early clinical and programmatic outcomes with tenofovir-based antiretroviral therapy in Zambia</article-title><source>J Acquir Immune Defic Syndr</source><year>2010</year><volume>54</volume><fpage>63</fpage><lpage>70</lpage><pub-id pub-id-type="pmid">20009765</pub-id></element-citation></ref><ref id="ref30"><label>30</label><element-citation publication-type="webpage"><article-title>World Health Organization</article-title><source>WHO vaccine preventable disease monitoring system: 2010 global summary</source><date-in-citation>Last Accessed on 2011 Jan 20</date-in-citation><comment>Available from:
<uri xlink:type="simple" xlink:href="http://apps.who.int/immunization_monitoring/en/globalsummary/countryprofileselect.cfm">http://apps.who.int/immunization_monitoring/en/globalsummary/countryprofileselect.cfm</uri></comment></element-citation></ref><ref id="ref31"><label>31</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Burnett</surname><given-names>RJ</given-names></name><name><surname>Francois</surname><given-names>G</given-names></name><name><surname>Kew</surname><given-names>MC</given-names></name><name><surname>Leroux-Roels</surname><given-names>G</given-names></name><name><surname>Meheus</surname><given-names>A</given-names></name><name><surname>Hoosen</surname><given-names>AA</given-names></name><etal></etal></person-group><article-title>Hepatitis B virus and human immunodeficiency virus co-infection in sub-Saharan Africa: A call for further investigation</article-title><source>Liver Int</source><year>2005</year><volume>25</volume><fpage>201</fpage><lpage>13</lpage><pub-id pub-id-type="pmid">15780040</pub-id></element-citation></ref><ref id="ref32"><label>32</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Lukhwareni</surname><given-names>A</given-names></name><name><surname>Burnett</surname><given-names>RJ</given-names></name><name><surname>Selabe</surname><given-names>SG</given-names></name><name><surname>Mzileni</surname><given-names>MO</given-names></name><name><surname>Mphahlele</surname><given-names>MJ</given-names></name></person-group><article-title>Increased detection of HBV DNA in HBsAg-positive and HBsAg-negative South African HIV/AIDS patients enrolling for highly active antiretroviral therapy at a Tertiary Hospital</article-title><source>J Med Virol</source><year>2009</year><volume>81</volume><fpage>406</fpage><lpage>12</lpage><pub-id pub-id-type="pmid">19152393</pub-id></element-citation></ref><ref id="ref33"><label>33</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Pang</surname><given-names>T</given-names></name><name><surname>Peeling</surname><given-names>RW</given-names></name></person-group><article-title>Diagnostic tests for infectious diseases in the developing world: Two sides of the coin</article-title><source>Trans R Soc Trop Med Hyg</source><year>2007</year><volume>101</volume><fpage>856</fpage><lpage>7</lpage><pub-id pub-id-type="pmid">17544047</pub-id></element-citation></ref><ref id="ref34"><label>34</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Yager</surname><given-names>P</given-names></name><name><surname>Domingo</surname><given-names>GJ</given-names></name><name><surname>Gerdes</surname><given-names>J</given-names></name></person-group><article-title>Point-of-care diagnostics for global health</article-title><source>Annu Rev Biomed Eng</source><year>2008</year><volume>10</volume><fpage>107</fpage><lpage>44</lpage><pub-id pub-id-type="pmid">18358075</pub-id></element-citation></ref><ref id="ref35"><label>35</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Wester</surname><given-names>CW</given-names></name><name><surname>Bussmann</surname><given-names>H</given-names></name><name><surname>Moyo</surname><given-names>S</given-names></name><name><surname>Avalos</surname><given-names>A</given-names></name><name><surname>Gaolathe</surname><given-names>T</given-names></name><name><surname>Ndwapi</surname><given-names>N</given-names></name><etal></etal></person-group><article-title>Serological evidence of HIV-associated infection among HIV-1-infected adults in Botswana</article-title><source>Clin Infect Dis</source><year>2006</year><volume>43</volume><fpage>1612</fpage><lpage>5</lpage><pub-id pub-id-type="pmid">17109297</pub-id></element-citation></ref><ref id="ref36"><label>36</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Rouet</surname><given-names>F</given-names></name><name><surname>Chaix</surname><given-names>ML</given-names></name><name><surname>Inwoley</surname><given-names>A</given-names></name><name><surname>Msellati</surname><given-names>P</given-names></name><name><surname>Viho</surname><given-names>I</given-names></name><name><surname>Combe</surname><given-names>P</given-names></name><etal></etal></person-group><article-title>HBV and HCV prevalence and viraemia in HIV-positive and HIV-negative pregnant women in Abidjan, Cote d’Ivoire: The ANRS 1236 study</article-title><source>J Med Virol</source><year>2004</year><volume>74</volume><fpage>34</fpage><lpage>40</lpage><pub-id pub-id-type="pmid">15258966</pub-id></element-citation></ref><ref id="ref37"><label>37</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Shimelis</surname><given-names>T</given-names></name><name><surname>Torben</surname><given-names>W</given-names></name><name><surname>Medhin</surname><given-names>G</given-names></name><name><surname>Tebeje</surname><given-names>M</given-names></name><name><surname>Andualm</surname><given-names>A</given-names></name><name><surname>Demessie</surname><given-names>F</given-names></name><etal></etal></person-group><article-title>Hepatitis B virus infection among people attending the voluntary counselling and testing centre and anti-retroviral therapy clinic of St Paul's General Specialised Hospital, Addis Ababa, Ethiopia</article-title><source>Sex Transm Infect</source><year>2008</year><volume>84</volume><fpage>37</fpage><lpage>41</lpage><pub-id pub-id-type="pmid">17804606</pub-id></element-citation></ref><ref id="ref38"><label>38</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Mboto</surname><given-names>CI</given-names></name><name><surname>Fielder</surname><given-names>M</given-names></name><name><surname>Davies-Russell</surname><given-names>A</given-names></name><name><surname>Jewell</surname><given-names>AP</given-names></name></person-group><article-title>Hepatitis C virus prevalence and serotypes associated with HIV in The Gambia</article-title><source>Br J Biomed Sci</source><year>2010</year><volume>67</volume><fpage>140</fpage><lpage>4</lpage><pub-id pub-id-type="pmid">20973409</pub-id></element-citation></ref><ref id="ref39"><label>39</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Harania</surname><given-names>RS</given-names></name><name><surname>Karuru</surname><given-names>J</given-names></name><name><surname>Nelson</surname><given-names>M</given-names></name><name><surname>Stebbing</surname><given-names>J</given-names></name></person-group><article-title>HIV, hepatitis B and hepatitis C coinfection in Kenya</article-title><source>AIDS</source><year>2008</year><volume>22</volume><fpage>1221</fpage><lpage>2</lpage><pub-id pub-id-type="pmid">18525268</pub-id></element-citation></ref><ref id="ref40"><label>40</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Moore</surname><given-names>E</given-names></name><name><surname>Beadsworth</surname><given-names>MB</given-names></name><name><surname>Chaponda</surname><given-names>M</given-names></name><name><surname>Mhango</surname><given-names>B</given-names></name><name><surname>Faragher</surname><given-names>B</given-names></name><name><surname>Njala</surname><given-names>J</given-names></name><etal></etal></person-group><article-title>Favourable one-year ART outcomes in adult Malawians with hepatitis B and C co-infection</article-title><source>J Infect</source><year>2010</year><volume>61</volume><fpage>155</fpage><lpage>63</lpage><pub-id pub-id-type="pmid">20470823</pub-id></element-citation></ref><ref id="ref41"><label>41</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Nyirenda</surname><given-names>M</given-names></name><name><surname>Beadsworth</surname><given-names>MB</given-names></name><name><surname>Stephany</surname><given-names>P</given-names></name><name><surname>Hart</surname><given-names>CA</given-names></name><name><surname>Hart</surname><given-names>IJ</given-names></name><name><surname>Munthali</surname><given-names>C</given-names></name><etal></etal></person-group><article-title>Prevalence of infection with hepatitis B and C virus and coinfection with HIV in medical inpatients in Malawi</article-title><source>J Infect</source><year>2008</year><volume>57</volume><fpage>72</fpage><lpage>7</lpage><pub-id pub-id-type="pmid">18555534</pub-id></element-citation></ref><ref id="ref42"><label>42</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Ahmed</surname><given-names>SD</given-names></name><name><surname>Cuevas</surname><given-names>LE</given-names></name><name><surname>Brabin</surname><given-names>BJ</given-names></name><name><surname>Kazembe</surname><given-names>P</given-names></name><name><surname>Broadhead</surname><given-names>R</given-names></name><name><surname>Verhoeff</surname><given-names>FH</given-names></name><etal></etal></person-group><article-title>Seroprevalence of hepatitis B and C and HIV in Malawian pregnant women</article-title><source>J Infect</source><year>1998</year><volume>37</volume><fpage>248</fpage><lpage>51</lpage><pub-id pub-id-type="pmid">9892528</pub-id></element-citation></ref><ref id="ref43"><label>43</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Pirillo</surname><given-names>MF</given-names></name><name><surname>Bassani</surname><given-names>L</given-names></name><name><surname>Germinario</surname><given-names>EA</given-names></name><name><surname>Mancini</surname><given-names>MG</given-names></name><name><surname>Vyankandondera</surname><given-names>J</given-names></name><name><surname>Okong</surname><given-names>P</given-names></name><etal></etal></person-group><article-title>Seroprevalence of hepatitis B and C viruses among HIV-infected pregnant women in Uganda and Rwanda</article-title><source>J Med Virol</source><year>2007</year><volume>79</volume><fpage>1797</fpage><lpage>801</lpage><pub-id pub-id-type="pmid">17935164</pub-id></element-citation></ref><ref id="ref44"><label>44</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Di Bisceglie</surname><given-names>AM</given-names></name><name><surname>Maskew</surname><given-names>M</given-names></name><name><surname>Schulze</surname><given-names>D</given-names></name><name><surname>Reyneke</surname><given-names>A</given-names></name><name><surname>McNamara</surname><given-names>L</given-names></name><name><surname>Firnhaber</surname><given-names>C</given-names></name></person-group><article-title>HIV-HBV coinfection among South African patients receiving antiretroviral therapy</article-title><source>Antivir Ther</source><year>2010</year><volume>15</volume><issue>3 Pt B</issue><fpage>499</fpage><lpage>503</lpage><pub-id pub-id-type="pmid">20516571</pub-id></element-citation></ref><ref id="ref45"><label>45</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Hoffmann</surname><given-names>CJ</given-names></name><name><surname>Charalambous</surname><given-names>S</given-names></name><name><surname>Martin</surname><given-names>DJ</given-names></name><name><surname>Innes</surname><given-names>C</given-names></name><name><surname>Churchyard</surname><given-names>GJ</given-names></name><name><surname>Chaisson</surname><given-names>RE</given-names></name><etal></etal></person-group><article-title>Hepatitis B virus infection and response to antiretroviral therapy (ART) in a South African ART program</article-title><source>Clin Infect Dis</source><year>2008</year><volume>47</volume><fpage>1479</fpage><lpage>85</lpage><pub-id pub-id-type="pmid">18937580</pub-id></element-citation></ref><ref id="ref46"><label>46</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Kallestrup</surname><given-names>P</given-names></name><name><surname>Zinyama</surname><given-names>R</given-names></name><name><surname>Gomo</surname><given-names>E</given-names></name><name><surname>Dickmeiss</surname><given-names>E</given-names></name><name><surname>Platz</surname><given-names>P</given-names></name><name><surname>Gerstoft</surname><given-names>J</given-names></name><etal></etal></person-group><article-title>Low prevalence of hepatitis C virus antibodies in HIV-endemic area of Zimbabwe support sexual transmission as the major route of HIV transmission in Africa</article-title><source>AIDS</source><year>2003</year><volume>17</volume><fpage>1400</fpage><lpage>2</lpage><pub-id pub-id-type="pmid">12799566</pub-id></element-citation></ref></ref-list></back></pmc></record>Pour manipuler ce document sous Unix (Dilib)
EXPLOR_STEP=$WICRI_ROOT/Wicri/Sante/explor/SidaSubSaharaV1/Data/Pmc/Corpus
HfdSelect -h $EXPLOR_STEP/biblio.hfd -nk 002642 | SxmlIndent | more
Ou
HfdSelect -h $EXPLOR_AREA/Data/Pmc/Corpus/biblio.hfd -nk 002642 | SxmlIndent | more
Pour mettre un lien sur cette page dans le réseau Wicri
{{Explor lien
|wiki= Wicri/Sante
|area= SidaSubSaharaV1
|flux= Pmc
|étape= Corpus
|type= RBID
|clé= PMC:3162815
|texte= HIV, Hepatitis B, and Hepatitis C in Zambia
}}
Pour générer des pages wiki
HfdIndexSelect -h $EXPLOR_AREA/Data/Pmc/Corpus/RBID.i -Sk "pubmed:21887060" \
| HfdSelect -Kh $EXPLOR_AREA/Data/Pmc/Corpus/biblio.hfd \
| NlmPubMed2Wicri -a SidaSubSaharaV1
| This area was generated with Dilib version V0.6.32. |  |