Occult hepatitis B virus infection in people with haemophilia in South Africa

Abstract

BACKGROUND : Occult hepatitis B virus (HBV) infection (OBI) is defined as the presence of HBV DNA in the absence of HBV surface antigen (HBsAg) serological markers. Despite the high prevalence of HBV infection in many communities, OBI prevalence among people with haemophilia (PWH) remains poorly characterised in South Africa. AIMS : The aim of the study was to determine the prevalence of OBI and characterise viral complications of patients attending haemophilia clinics in three tertiary hospitals in Gauteng, namely, the Steve Biko Academic Hospital (SBAH), Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) and Dr George Mukhari Academic Hospital (DGMAH). METHODS : This descriptive cross-sectional study was approved by the ethics committees of each participant centre. Haemophilia patients of any severity or inhibitor status with positive serological markers of HBV infection and immunity were excluded from the study. We measured Hepatitis B DNA of those with negative serological markers using a quantitative hepatitis B PCR assay. RESULTS : Of the 76 patients screened, 66 male patients were included in the study. The median age was 29 years. Haemophilia A and haemophilia B comprised 89% and 11% of the cohort, respectively. The majority of patients were taking prophylactic factor replacement therapy (72%) as opposed to episodic therapy (28%). A total of 10 patients (15%) had inhibitors. Five patients (8%) were HIV seropositive. Ten patients (15%) had no documented evidence of being vaccinated against hepatitis B infection. Anti-hepatitis B core antibodies were positive in 5 patients (8%). All patients had a negative hepatitis B surface antigen result. All patients demonstrated negative hepatitis B PCR results. CONCLUSION : In this cohort of PWH from 3 centres, none showed evidence of occult HBV infection.