Prevalence and Genotypic Characterization of HBV in HIV-Infected Patients from Kwazulu-Natal, South Africa

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Abstract Introduction: The co-infection of HIV with HBV is very common due to shared mode of transmission. HBV/HIV co-infection impact on low HBeAg expression, high HBV replication, causes progressive liver disease, cirrhosis, liver cancer and high mortality. Coinfection may lead to cross-resistance of HBV and HIV drugs due to drug-related immune therapeutic pressure or hepatotoxicity. These challenges necessitate continuous surveillance for HBV among HIV infected individuals to aid patient treatment management. Hence we conducted this study to characterise HBV among HIV infected patients in Durban, KwaZuluNatal of South Africa.Methods: Serum was screened for HBsAg using ELISA, followed by DNA extraction from all samples. Genotyping of HBV was done through PCR amplification, Sanger sequencing and phylogenetic analysis. Results: Of the 50 samples in this study 100% (n=50/50) were HBsAg positive. HBV/HIV coinfection was 78% (n=41/50) based on PCR amplification of the HBV partial surface gene and 92% (n=38/41) of the amplicons were successfully sequenced. Phylogenetic and sequence analyses identified patients nucleotide sequence as Genotype A. Mutations prevalence in the HBsAg region was 47% (n=18/38); including mutations associated with diagnostic failure (K122R and T143S) and 7 vaccines escape mutations (P127T, G145R, S207N, Y200T, E164D, Y206H and L209V). Prevalence of mutations associated with drug resistance was 57% (n=8/14) within the reverse transcriptase region. Drug resistance mutations included lamivudine resistance at 71% (n=5/7), telbivudine resistance at 57% (n=4/7), 14% (n=1/7) for entecavir resistance and 43% (n=3/7) for adefovir resistance. Mutations causing resistance to lamivudine and telbivudine were M204V, L180M, V163I, and S202K; with S202K also causing resistance to entecavir and adefovir resistance mutation were I253Y, I223V and M250I. The drug susceptibility prevalence was 68% (n=26/38). Multiple drug resistance mutations within a single sample contained L180M, M204V, S202K and M250I mutations. Conclusion: This study shows the predominance of HBV genotype A in HIV-infected patients and the HBV mutations present in HBV/HIV co-infected individuals. HBV mutations associated with drug resistance suggest the need for continuous HBV screening and use of tenofovir ART regimen among HBV/HIV co-infected individuals.

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