Molecular Diversity of Hepatitis B Virus in HIV Infected Patients at Mbagathi District Hospital, Nairobi City County.
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Date
2024-06
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Kenyatta University
Abstract
With increasing access to antiretroviral therapy (ART) across Sub-Saharan Africa, HIV-infected
individuals live longer and are frequently co-infected with HBV due to similar transmission routes.
Persons with Hepatitis B Virus and HIV dual-infection advance more swiftly to end-stage hepatic disease.
With 8-15% genomic divergence by DNA sequence, HBV is currently classified into 10 genetic variants,
from A to J with numerous subtypes. HBV genotypes have been clarified as influencing the clinical
outcome of the chronic disease in hosts. Considering paucity of data on HBV genotypes among HBV/HIV
co-infected individuals in Kenya and the significance of HBV variants in antiretroviral therapy response,
a cross-sectional study on the molecular diversity of Hepatitis B virus genotypes and the risk factors
among HIV infected patients in Kenya was undertaken. The systematic random sampling was used to
recruit 180 HIV seropositive male and female individuals attending routine CD4+ T-lymphocyte and viral
load laboratory monitoring. A structured questionnaire was administered to capture socio-epidemiological
data while an ELISA for qualitative testing of HBsAg in human serum was used and HBV DNA was
extracted from 9 HBsAg seropositive samples and HBV genotypes established in 5 nucleic acids by
nested-PCR of pre-S gene, direct sequencing and phylogenetic tree clustering. The HBV prevalence was
found to be 5.0% serologically and 2.8% by PCR. Drug injection, heavy alcohol consumption, low use of
protection during sexual intercourse and increased frequency of sexually transmitted infections were
found to be direct risk factors for increased HBV infection. This study reveals that HBV genotype A1
(60%) and D (D6 and D7) were the most prevalent and they showed very low genetic diversity. In addition,
these strains indicated very close phylogenetic relationship to those isolated from Sudan, S. Africa,
Botswana and Tunisia. The five isolate genotypes were found to have susceptible mutations in S gene for
Lamivudine, Adefovir, Entecavir and Tenofovir. In conclusion, the HBV/A1 was predominant variant and
this imply the possibility of increased incidence of the HBV genotype A1 in Kenya and indeed across the
region due to increased migration and regional interaction of human populations
Description
A Research Thesis Submitted in Partial Fulfiilment for the Award of Degree of Master of Science (Infectious Diseases) in the School of Health Sciences of Kenyatta University, June 2024.
Supervisors
1. Washington Arodi
2. Marion Warigia