Browsing by Author "Ngcapu, Sinaye."

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Characterization of nucleoside reverse transcriptase inhibitor-associated mutations in the RNAse H region of HIV-1 subtype c infected individuals.
(Viruses., 2017) Ngcapu, Sinaye.; Theys, Kristof.; Libin, Pieter.; Marconi, Vincent C.; Sunpath, Henry.; Ndung'u, Peter Thumbi.; Gordon, Michelle Lucille.
Abstract available in pdf.
Frequency and phenotype of Immune cell subsets in different regions of the human cervix : implications for HIV susceptibility.
(2018) Pillay, Nishlin.; Ngcapu, Sinaye.
Abstract available in PDF file.
Genital inflammation undermines the effectiveness of tenofovir gel in preventing HIV acquisition in women.
(Nature Publishing Group., 2018) McKinnon, Lyle R.; Liebenberg, Lenine Julie.; Yende-Zuma, Fortunate Nonhlanhla.; Archary, Derseree.; Ngcapu, Sinaye.; Sivro, Aida.; Nagelkerke, Nico.; Garcia Lerma, Gerardo.; Kashuba, Angela D. M.; Masson, Lindi.; Mansoor, Leila Essop.; Abdool Karim, Quarraisha.; Abdool Karim, Salim Safurdeen.; Passmore, Jo-Ann Shelley.
Abstract available in pdf.
Genital tract immune activation, inflammation and sexually transmitted infections in CAPRISA 008 trial participants.
(2016) Mhlungu, Sanele Nobleman.; Liebenberg, Lenine Julie.; Ngcapu, Sinaye.
Abstract available in PDF file.
Impact of Chlamydia trachomatis on inhibitory capabilities of broadly neutralizing antibodies in vitro.
(2021) Magini, Stanley Nzuzo.; Ngcapu, Sinaye.; Mzobe, Gugulethu Favourate.; Ndlovu, Bongiwe Goodness.
Abstract available in PDF.
Impact of injectable hormonal contraceptives on innate immune environment in the genital tract in women at high risk for HIV-1 infection.
(2015) Ngcapu, Sinaye.; Abdool Karim, Quarraisha.; Passmore, Jo-Ann Shelley.
Abstract available in PDF file.
The impact of semen exposure on cytokine response and bacterial vaginosis in the female genital tract.
(2018) Mngomezulu, Khanyisile Happiness.; Ngcapu, Sinaye.; Baxter, Cheryl.
Background: Diverse microbial communities and inflammatory cytokine responses in the lower female genital tract (FGT) are closely associated with increased human immunodeficiency virus (HIV-1) risk, possibly through increasing mucosal HIV target cell frequency and T-cell activation. The presence of semen in the vagina during unprotected sex has been associated with short-term activation of mucosal immunity. Here, we investigated the extent to which partner semen impacts on cytokine and microbial profiles measured in 248 HIV-uninfected women at high risk for HIV infection. Methods: We assessed the semen exposure in SoftCup supernatants by quantifying prostate specific antigen (PSA) levels using enzyme-linked immunosorbent assay (ELISA). Luminex was used to measure 48 cytokines in SoftCup supernatants and the vaginal swabs were used for diagnosis of bacterial vaginosis by Nugent score. Results: PSA, which denotes semen exposure within 48 hours prior to sampling, was detected in 19% (43/248) of SoftCup supernatants. Of the 43 PSA positive women, 70% (30/43) had self-reported condom use at their last sex act and 84% (36/43) had non-Lactobacillus dominant microbiota (Nugent score >7). In addition, PSA was significantly associated with prevalent bacterial vaginosis (Relative Risk (RR), 2.609; 95% Confidence Interval (CI), 1.104 - 6.165; p = 0.029), after adjusting for potential confounders such as age, STIs, current contraceptive use and condom use. Furthermore, women with detectable PSA had high median concentrations of Macrophage inflammatory protein- beta (MIP-1β) (p=0.047) compared to those without PSA. Conclusion: These findings suggest that the presence of semen has a potential to alter the inflammatory response and microbial communities of the FGT, which may facilitate recruitment of HIV susceptible cells, resulting in increased susceptibility to HIV-1 infection.
The impact of semen exposure on cytokine response and bacterial vaginosis in the female genital tract.
(2018) Mngomezulu, Khanyisile Happiness.; Ngcapu, Sinaye.; Baxter, Cheryl.
Background: Diverse microbial communities and inflammatory cytokine responses in the lower female genital tract (FGT) are closely associated with increased human immunodeficiency virus (HIV-1) risk, possibly through increasing mucosal HIV target cell frequency and T-cell activation. The presence of semen in the vagina during unprotected sex has been associated with short-term activation of mucosal immunity. Here, we investigated the extent to which partner semen impacts on cytokine and microbial profiles measured in 248 HIV-uninfected women at high risk for HIV infection. Methods: We assessed the semen exposure in SoftCup supernatants by quantifying prostate specific antigen (PSA) levels using enzyme-linked immunosorbent assay (ELISA). Luminex was used to measure 48 cytokines in SoftCup supernatants and the vaginal swabs were used for diagnosis of bacterial vaginosis by Nugent score. Results: PSA, which denotes semen exposure within 48 hours prior to sampling, was detected in 19% (43/248) of SoftCup supernatants. Of the 43 PSA positive women, 70% (30/43) had self-reported condom use at their last sex act and 84% (36/43) had non-Lactobacillus dominant microbiota (Nugent score >7). In addition, PSA was significantly associated with prevalent bacterial vaginosis (Relative Risk (RR), 2.609; 95% Confidence Interval (CI), 1.104 - 6.165; p = 0.029), after adjusting for potential confounders such as age, STIs, current contraceptive use and condom use. Furthermore, women with detectable PSA had high median concentrations of Macrophage inflammatory protein- beta (MIP-1β) (p=0.047) compared to those without PSA. Conclusion: These findings suggest that the presence of semen has a potential to alter the inflammatory response and microbial communities of the FGT, which may facilitate recruitment of HIV susceptible cells, resulting in increased susceptibility to HIV-1 infection.
The impact of semen exposure on the immune and microbial environments of the female genital tract.
(2021) Jewanraj, Janine.; Liebenberg, Lenine Julie.; Ngcapu, Sinaye.
Background: Semen is an immunomodulatory fluid that induces mucosal changes at the female genital tract (FGT) for sperm survival and conception. Semen-induced alterations necessary for reproduction may also modulate the inflammatory environment related to HIV risk in women. This thesis investigated the impact of semen exposure on biomarkers of female genital inflammation (GI) and the persistence of these associations over time. Methods: Stored genital specimens were assessed from HIV-negative women participating in the CAPRISA 008 trial. Cervicovaginal lavage (CVL) samples were screened for Y-chromosome DNA (YcDNA) by real-time PCR as a biomarker of semen exposure within 15 days of genital sampling. Prostate-specific antigen (PSA) detection by ELISA stratified CVLs into semen exposure within 48 hours (PSA+YcDNA+) and between 3-15 days (PSA-YcDNA+). Vaginal cytokine concentrations, matrix metalloproteinases (MMPs), and tissue inhibitors of metalloproteinases (TIMPs) were assessed in CVLs using multiplexed ELISA. Endocervical T-cell frequencies were measured in cytobrushes by flow-cytometry. Vaginal microbes and sexually transmitted infections (STIs) were detected in vulvovaginal swabs by PCR. Results: Self-reported condom use as a measure of semen exposure was not associated with changes in the FGT microenvironments. Conversely, YcDNA detection predicted significant increases in several cytokines, barrier-related proteins, and Prevotella bivia detection (p=0.001). Since YcDNA detection alone was not associated with the immune environment linked to HIV risk, this thesis further investigated the contribution of more recent sex to female GI. PSA detection (semen exposure within 48 hours) was associated with higher YcDNA concentrations (p<0.0001), suggesting a relationship between the timing of semen exposure and vaginal YcDNA concentrations after condomless sex. In support of this, both PSA detection and higher YcDNA concentrations predicted significant increases in several cytokines, barrier-related proteins (MMP-2, TIMP-1, TIMP-4), and higher frequencies of activated CD4+HLA-DR+ T-cells (p=0.032) and CD4+CCR5+HLA-DR+ HIV targets (p=0.046). PSA detection was also associated with increased detection of several bacterial vaginosis (BV)-associated microbes and reduced Lactobacillus jensenii detection. Conclusion: Recent semen exposure contributes to the inflammatory environment associated with HIV risk in women. These studies highlight the need for clinical and immunological studies of STIs and their biomedical interventions to consider semen’s contribution to the immune and microbial microenvironments of the FGT.
The Impact of vaginal microbiota on human Papillomavirus infection.
(2022) Ntuli, Lungelo.; Ngcapu, Sinaye.; Mtshali, Andile Ntombikhona.; Mzobe, Gugulethu Favourate.
Background: Cervical human papillomavirus (HPV) infection is the most common sexually transmitted infection (STI) in sub-Saharan African women of reproductive age. While most women clear HPV infection, persistent infection with high-risk HPV is the most common nonsystem biological risk factor for cervical cancer development. Increased levels of proinflammatory cytokines and overgrowth of diverse microbial communities have been implicated in undermining the clearance of the infection and promoting oncogenesis. Here we aimed to evaluate the role of vaginal microbiota composition in the persistence and clearance of HPV infections in women. Methods: This study included the assessment of 56 women who participated in the CAPRISA 083 cohort. The CAPRISA 083 study evaluated point of care STI testing immediate treatment and expedited partner therapy. Sexually transmitted infections (STIs) and BV were screened using the GeneXpert system or OSOM Trichomonas rapid test and Nugent score, respectively. Vaginal swabs and SoftCup genital secretions were collected at enrolment, 6 weeks, and 13 weeks posttreatment. The Roche Linear Array was used for HPV genotyping, and the vaginal microbiome was characterized using 16S rRNA sequencing. Results: The study demonstrated a 36/56 (64 %), 28/56 (50 %), and 36/56 (64 %) prevalent of HPV at baseline, 6 weeks and 13 weeks, respectively. The prevalence of high-risk HPV infection at baseline was 58%, 61% at 6 weeks, and 45% at 13 weeks. HPV 16, 45, 58, and 59 were the most dominant high-risk genotypes in all visits, while HPV 6 was the least common. Overall, 46% (26/56) of participants cleared any HPV genotype, while 45% (25/56) acquired and 38% (21/56) had persisted any HPV genotype at follow-up visits. Alpha diversity of the vaginal microbiome of women with HPV (p value= 0.57) and high-risk HPV (p value= 0.6) infection did not differ significantly to that in vaginal microbiome from uninfected women. LEfSe analysis identified Lactobacillus spp. (particularly L. iners) as potential biomarkers for HPV clearance between visits, whereas HPV persistence was associated with enrichment of Sneathia amnii and other BVassociated bacteria. Conclusion: While our data do not indicate the causal link between the diverse genital microbiome and HPV clearance or persistent, L. iners and Sneathia abundance were associated with HPV clearance and persistent, respectively. These data suggest the need for longitudinal investigation to confirm a biological mechanism for this relationship, which will likely benefit cervical cancer management.
In vitro effects of intravaginal insertion products (IVIPs) on biomarkers of inflammation and immune cellular activation in the era of HIV.
(2019) Hlophe, Rejoice Zanele.; Gumbi, Pamela Phumelele.; Sivro, Aida.; Ngcapu, Sinaye.
The use of vaginal products is associated with increased HIV acquisition risk, but the mechanism is not fully understood. Vaginal practices entail the use of a wide variety of products which can alter the vaginal environment to achieve a desired state. Strong motivations for vaginal practices include women’s desire to maintain stable relationships, manage health, hygiene and sexuality. This adjustment of the vaginal microenvironment may increase HIV acquisition risk. High levels of inflammation and immune activation in the female genital tract are associated with a threefold increase in HIV acquisition risk. We hypothesized that intravaginal insertion products (IVIPs) may be linked to high levels of inflammation and immune activation in the female genital tract which may subsequently lead to an increased risk of HIV acquisition Objective The pH of the IVIPs (Kuber, Snuff, Alum, Savlon and Rose water) was measured and the cytotoxicity of the IVIPs was evaluated by determining their effect on cell viability at different dilutions (Neat/stock, 1/5, 1/10, 1/100 and 1/1000). The mechanisms by which potassium aluminium sulfate (“Alum”) and smokeless tobacco (“snuff”) impact cellular activation and inflammation were investigated using peripheral blood mononuclear cells (PBMCs) in vitro. Methods The pH of alum, snuff, kuber, savlon and rose water was measured at different dilutions (Neat/Stock, 1/5, 1/10, 1/100 and 1/1000). The effect of the IVIPs on cell viability was determined by exposing PBMCs to the different dilutions of IVIPs mentioned above. PBMCs from 26 HIV-negative healthy donors were unstimulated (negative control) or stimulated for 3 hours at 37°C with 1/1000 dilutions of 450 mg/ml of alum or snuff and 10μg/ml of PHA (positive control). The PBMC supernatants were collected following PBMC stimulation, and eleven cytokines were measured from 12 of the 26 PBMC supernatants. Pro-inflammatory (IL-1β, TNF-α, IL-6), chemokines (IL-8, IP-10, MIP-1α, MIP-1β, MCP-1), hematopoietic (IL-7, GM-CSF) and regulatory (IL-10) cytokines were measured using Bio-Plex multiplex assay. The activation status of T lymphocytes was determined by evaluating CD38+, HLA-DR+, dual expression of CD38+HLA-DR+ and chemokine receptor CCR5+ expression from CD4+ and CD8+ T cells using flow cytometry assay. Results Alum stock solution was acidic with a pH of 2.62 whereas the snuff stock solution was basic with a pH of 9.11. Alum and savlon were found to have high cytotoxicity. Snuff exposed cell resulted in a significantly increased CCR5 chemokine expression in CD4+ T cells when compared to the unexposed cells (p=0.0483) and also when compared to alum exposed cells (p=0.0446). However, snuff exposure did not significantly increase any of the activation markers in CD8+ T cells and it did not change the inflammatory cytokine profile. In CD8+ T lymphocytes the CD38+ biomarker was significantly more expressed in unexposed cells compared to the alum exposed cells (p=0.0185). Alum exposed cells significantly increased expression of HLADR+ (P=0.0348) and also the dual expression of CD38+HLA-DR+in CD8+ T cells (p=0.0208) when compared to the unexposed cells and was also associated with significantly high levels of cytokines IP-10 (p=0.039), MCP-1 (P=0.0024), MIP-1α (p=0.0005), IL-6 (P=0.0005), TNF-α (P=0.0020), IL-7 (P=0.0005) and GM-SCF (P=0.0005) when compared to the unexposed cells. Conclusion This study is the first of its kind to identify a possible link between intravaginal insertion products and inflammation. Alum, in particular, was more inflammatory compared to snuff. These findings may help explain the previous observations of an increased HIV acquisition risk in IVIP users. Future research can extend the current pilot study on an invitro human vaginal epithelial cell model. Knowledge from this work and future studies is crucial in developing new female-initiated interventions for preventing HIV acquisition.
Inflammatory cytokine biomarkers to identify women with asymptomatic sexually transmitted infections and bacterial vaginosis who are at high risk of HIV infection.
(BMJ., 2016) Masson, Lindi.; Arnold, Kelly B.; Little, Francesca.; Mlisana, Koleka Patience.; Lewis, David A.; Mkhize, Nonhlanhla.; Gamieldien, Hoyam.; Ngcapu, Sinaye.; Johnson, Leigh.; Lauffenburger, Douglas A.; Abdool Karim, Quarraisha.; Abdool Karim, Salim Safurdeen.; Passmore, Jo-Ann Shelley.
Abstract available in pdf.
Investigation of intravaginal practices as a factor associated with a high prevalence of genital human papillomavirus infection in adolescent girls.
(2021) Mntambo, Ntombenhle.; Gumbi, Pamela Phumelele.; Ngcapu, Sinaye.
Background: Human papillomavirus (HPV) is a common sexually transmitted infection (STI) in women which mainly infects the mucosal areas. Young women are disproportionately infected by HPV, and factors that may render adolescents or younger women more vulnerable to HPV acquisition than older women have not been fully elucidated. This study aimed to investigate the associations between the prevalence of HPV, the use of intravaginal products, the immune activation status of cervical T cells, and alterations of the composition and concentrations of antimicrobial peptides (AMPs) in vaginal fluid among adolescent females close to their sexual debut and older women in KwaZulu-Natal. Methodology: Genital specimens (cervical cytobrush and cervicovaginal swabs) were collected from 154 female participants aged 14-19 and 25-35 years. From cervicovaginal swabs, HPV genotyping was done using a deoxyribonucleic acid (DNA) Flow hybridization system. Flow cytometry was conducted from cervical cytobrush specimens (evaluating CD38+, HLA-DR+, andCCR5+ expressions) to assess T-cell immune activation status. Enzyme-linked Immunosorbent Assay (ELISA) kits were used to measure genital concentrations of human β- defensin (HBD-1, HBD-2), and psoriasin from cervicovaginal swabs. Statistical tests conducted were Robust Poisson regression models (RPRM), the Tukey multiple comparison adjustment, t-test, and Mann Whitney U test. 𝑃 values of <0.05 were statistically significant. Results: HPV prevalence was 85%, with high-risk genotypes being the most prevalent. The majority of the cohort was infected with multiple genotypes (76.62%). Genotypes associated with cancer and current Gardasil®9 HPV vaccine targets were more common (53.9%) than those associated with genital warts (14.9%). The risk of HPV in adolescent females was 15.9% higher than in adult females. The use of vaginal inserted products (VIPs) was associated with a 40% higher risk of contracting genotypes related to cancer (p=0.0503) compared to nonusers. The risk of HPV infection for adolescents using VIPs was 23% higher than that of adults using VIPs. However, these differences were not statistically significant at a 5% level of significance. Sexual debut after 18 years significantly reduced the risk of overall HPV infection (p=0.0040) and infection with genotypes associated with cancer (p=0.0024). When comparing HPV infected adolescents and adults, the proportion of activated CD4+ T cells was significantly higher in adolescents, particularly in CD4+ HLA-DR+ cells (p=0.0008). CD8+ T cells showed no difference. A significantly higher concentration of HBD-2 was observed in HPV+ adults compared to HPV- adults (p=0.0215) and HPV+ adolescents (p=0.0189). Conclusion: The overall HPV prevalence is higher than the previously reported prevalence in KwaZulu-Natal province. In addition, we demonstrate that the use of VIPs may be associated with some HPV infection risk, particularly in adolescent females. This finding suggests that young women should be warned about the potential risk of using VIPs. We also confirm that the age-phase, delay in sexual debut, and the number of sexual life partners have significant associations with HPV genotypes linked to cancer, highlighting the importance and the urgency of vaccinating young girls with Gardasil®9 HPV vaccine. Adolescents with HPV have significantly higher levels of activated CD4+ T cells in their cervical mucosa, suggesting the presence of reactive activated cells that lack efficiency in the clearing of HPV infection in this age group. HPV infection upregulates HBD-2 levels during HPV infection, notably significantly higher in adult females than in adolescents. This investigation has generated new insights into the risk factors for HPV acquisition in young women. These findings need to be confirmed further by larger cohort size studies, essential for HPV prevention.
Lower concentrations of chemotactic cytokines and soluble innate factors in the lower female genital tract associated with the use of injectable hormonal contraceptive.
(Elsevier., 2015) Ngcapu, Sinaye.; Masson, Lindi.; Sibeko, Sengeziwe.; Werner, Lise.; McKinnon, Lyle R.; Mlisana, Koleka Patience.; Shey, Muki Shehu.; Samsunder, Natasha.; Abdool Karim, Salim Safurdeen.; Abdool Karim, Quarraisha.; Passmore, Jo-Ann Shelley.
Abstract available in pdf.
Modulation of female genital tract-derived dendritic cell migration and activation in response to inflammatory cytokines and toll-like receptor agonists.
(Shey, M.S., Maharaj, N., Archary, D., Ngcapu, S., Garrett, N., Abdool Karim, S.S. and Passmore, J.A.S. 2016. Modulation of female genital tract-derived dendritic cell migration and activation in response to inflammatory cytokines and toll-like receptor agonists. PloS One 11(5), e0155668., 2016) Shey, Muki Shehu.; Maharaj, Niren Ray.; Archary, Derseree.; Ngcapu, Sinaye.; Garrett, Nigel Joel.; Abdool Karim, Salim Safurdeen.; Passmore, Jo-Ann Shelley.
Abstract available in pdf.
Nucleoside reverse transcriptase inhibitors-associated mutations in the RNase H region of HIV-1 isolates in South African adults and children failing highly active antiretroviral therapy.
(2012) Ngcapu, Sinaye.; Gordon, Michelle Lucille.
Background: The South African national treatment program includes NRTIs in both first and second line highly active antiretroviral therapy regimens. Recently, mutations in the RNase H domain have been associated with resistance to NRTIs. Here we investigated the prevalence and association of RNase H mutations with NRTI resistance in isolates of HIV-1 subtype C infected individuals. Methods: RNase H sequences from 134 NRTI treated (104 adults and 30 children) and 134 drug-naïve sequences (30 KZN isolates and 104 downloaded from the Los Alamos Database) were analyzed. Spearman’s rank correlation and a Bayesian network were used to explore the relationship between mutations occurring within the RNase H domain and NRTI treatment. Results: 130 of 134 samples clustered phylogenetically with HIV-1 subtype C, with one subtype A, two subtype B and two subtype D. All 30 sequences from HAART-naїve patients were classified as subtype C. Five mutations in the RNase H region had significantly higher frequency when comparing ART-naïve and NRTI-experienced patients. These were: (E438GKR, L517ISV, K527GENQR, E529DK and Q547HKR) (Table 1). Three mutations (E432D, A446SVY and Q507HK) showed decreased proportions in treatment-experienced isolates when compared to ART- naїve isolates. E438GKR was seen in 6.72% of treated versus only 0% of naїve isolates (p= 0.0034), L517IV was found in 17.16% of treated isolates versus 7.46% of naїve isolates (p= 0.0245). Similarly, K527GENQRS was found in 41.04% of treated isolates versus 26.12% of naїve isolates (p= 0.0138), and E529DK was more prevalent in treated (17.91%) when compared to 2.99% of naїve subtype isolates (p <0.001). Finally, Q547HKR was seen in 5.22% of treated versus 0% of naïve subtype C patients (p= 0.0144). Interestingly, samples of twenty treatment experienced individuals that did not show of the classical NRTI mutations in the RT domain harbored E438GKR, L517ISV, K527GENQR, E529DK and Q547HKR. Conclusion: Results obtained from this study suggested that drug resistance could be caused by mutations in the RNase H domain either alone (T470S), or in combination with mutations in the pol region (D67N and L491P). Phenotypic studies are required to understand the prevalence and impact of RNase H mutations, particularly E438GKR, T470S, L517ISV, K527GENQR, E529DK and Q547HKR on NRTI resistance in HIV-1 subtype C as suggested by our data. Further studies using site-directed mutagenesis may also reveal the impact of these mutations on viral fitness.
Seroprevalence of Hepatitis B virus infection in a household-based representative sample of African men and women in KwaZulu-Natal, South Africa.
(2018) Samsunder, Natasha.; Kharsany, Ayesha Bibi Mahomed.; Ngcapu, Sinaye.
Background: In South Africa, hepatitis B virus (HBV) infection remains a major cause of morbidity and mortality, however, little is known about the prevalence and distribution of HBV in some regions and populations. Methods: This secondary analysis is based on 9791 participants (15-49 years old) enrolled in the HIV incidence Provincial Surveillance System (HIPSS); a population-based household study undertaken from June 2014 to June 2015 in the Vulindlela (rural) and Greater Edendale (periurban) areas of the uMgungundlovu district, KwaZulu-Natal (KZN), South Africa. Interviewer administered questionnaires were completed to obtain demographic, psychosocial, behavioural and clinical information. Peripheral blood samples were collected and sera were tested for hepatitis B surface antigen (HBsAg) and all samples testing positive were further tested for hepatitis B e antigen (HBeAg) and hepatitis B e antibody (anti-HBe). The estimated weighted seroprevalence of HBV markers was calculated and the association of HBsAg with sociodemographic and behavioural factors measured. Results: The overall HBsAg prevalence was 4.0% (95% confidence interval (CI) 3.4-4.5); 4.8% (95% CI 3.8- 5.8) in men and 3.2% (95% CI 2.5-3.9) in women, P=0.01. Among HBsAg positive participants, 35.2% (95% CI 29.2-41.2) were HBeAg positive and 66.3% (95% CI 60.1-72.4) were anti-HBe positive. Among men 15-19 years old HBeAg seroprevalence was 92.2% (95% CI 75.8-100) compared to 4.4% (95% CI 0-13.7) in women in the same age group; P <0.01. HBsAg prevalence was 6.4% (95% CI 5.3-7.5) among HIV positive participants compared to 2.6% (95% CI 1.9-3.2) among HIV negative participants, (P<0.01) and was higher among HIV positive men 8.7% (95% CI 6.3-11.2) compared to HIV positive women 5.0% (95% CI 3.8-6.2), P<0.01. Conclusion: HBV infection, particularly among HIV positive men remains an important public health problem in rural and periurban communities in KwaZulu-Natal, South Africa. The prevalence of HBsAg and HBeAg highlight the importance of surveillance and an important missed opportunity for the scale up of programmes to achieve the goal of controlling HBV for public health benefit.