Epidemiology of hepatitis B virus co-infection among people living with HIV in four countries in sub-Saharan Africa

BACKGROUND: Hepatitis B virus (HBV) and human immunodeficiency virus (HIV) share transmission routes and are associated with morbidity in sub-Saharan Africa. Understanding the prevalence and demographic predictors of HBV co-infection among people living with HIV (PLWH) can inform integrated screening and treatment strategies. METHODS: We analyzed enrollment data from the African Cohort Study (AFRICOS), a prospective study of participants aged ≥15 years with and without HIV across 12 clinical sites in Kenya, Uganda, Tanzania, and Nigeria. HBV was diagnosed via hepatitis B surface antigen (Bio-Rad, Hercules, CA). Descriptive statistics summarized HBV prevalence by HIV status and demographic characteristics. Relative risk (RR) of HBV among PLWH compared to people without HIV was calculated. Among PLWH, multivariable logistic regression identified odds ratios (ORs) and 95% confidence intervals (CIs) for factors independently associated with HBV co-infection. RESULTS: Among 4,241 participants with valid HBV results, 3,439 were PLWH. HBV prevalence was 4.7% among PLWH and 4.2% among people without HIV (RR: 1.10; 95% CI: 0.77-1.59). Among PLWH, HBV prevalence was highest in Nigeria and lowest in Kenya (11.1% vs. 2.6%, p < 0.001), higher among males than females (6.7% vs. 3.2%, p < 0.001, and highest in participants aged ≥40 years and lowest in participants aged 15-19 years (5.8% vs. 0.2%, p < 0.001). In multivariable analysis, male sex (OR: 2.22 [95%CI: 1.59-3.09]), Nigeria residence (OR: 5.19 [95%CI: 3.35-8.05]), and age ≥ 40 (OR: 2.99 [95%CI: 1.74-5.13]) were independently associated with HBV co-infection. CONCLUSION: Routine HBV screening and targeted interventions are needed within HIV programs, especially for older males and in high-prevalence settings like Nigeria.