HIV and hepatitis B/C co-infection in KwaZulu-Natal from 2002 to 2010 : a retrospective database analysis.
Introduction Sub-Saharan Africa has the highest Human Immunodeficiency Virus (HIV) prevalence and the second highest Hepatitis B virus (HBV) and Hepatitis C virus (HCV) prevalence in the world. Co-infection of HIV, HBV and HCV occurs due to shared transmission routes and common risk factors. Existing studies from sub-Saharan Africa show wide variations in the prevalence of co-infections, depending on age, gender, race and geographical area. Aim The aim of this study was to describe HIV and HBV/HCV co-infections in KwaZulu-Natal from 2002 to 2010 using a laboratory database. Methods An observational, analytical, retrospective study design was used. The study setting was the National Health Laboratory Service Department of Virology, in Durban. The study population consisted of 507 834 individuals (all those with HIV, HBV or HCV test results from 2002 to 2010 recorded in the database). Results The overall sero-prevalence of HIV was 47%, HBV:12.05% and HCV:4.13%. The highest sero-prevalence of HIV and HCV was in the 30-35 year age group; for HBV it was in the 20-25 year age group. HIV sero-prevalence was higher in females, while HBV and HCV sero-prevalence was higher in males. The uThukela, Amajuba and Zululand health districts had the highest HIV, HBV and HCV sero-prevalence respectively. The sero-prevalence of HIV and HBV has decreased significantly over time, while there was no significant change in the sero-prevalence of HCV. Compared to those without HIV, individuals with HIV had increased odds of being positive for hepatitis markers: 3.19 for Hepatitis B surface antigen, 2.06 for Hepatitis B e antigen and 2.91 for HCV. Those with HIV were less likely to be positive for Hepatitis B surface antibodies. Those with Hepatitis B had a 1.38 times the odds of being co-infected with HCV compared to those without HBV. Discussion This study documented the high sero-prevalence of HIV, HBV and HCV over 9 years for KwaZulu-Natal. A significant number of HIV positive individuals are co-infected with either HBV or HCV. Recommendations The results of this study may guide public health decisions on the approach to diagnosis, treatment and prevention of HBV and HCV among those with HIV.