Hepatitis B virus and HIV co-infection among pregnant women in Rwanda.
BACKGROUND
Hepatitis B virus (HBV) affects people worldwide but the local burden especially in pregnant women and their new born babies is unknown. In Rwanda HIV-infected individuals who are also infected with HBV are supposed to be initiated on ART immediately. HBV is easily transmitted from mother to child during delivery. We sought to estimate the prevalence of chronic HBV infection among pregnant women attending ante-natal clinic (ANC) in Rwanda and to determine factors associated with HBV and HIV co-infection.


METHODS
This study used a cross-sectional survey, targeting pregnant women in sentinel sites. Pregnant women were tested for hepatitis B surface antigen (HBsAg) and HIV infection. A series of tests were done to ensure high sensitivity. Multivariable logistic regression was used to identify independent predictors of HBV-HIV co-infection among those collected during ANC sentinel surveillance, these included: age, marital status, education level, occupation, residence, pregnancy and syphilis infection.


RESULTS
The prevalence of HBsAg among 13,121 pregnant women was 3.7% (95% CI: 3.4-4.0%) and was similar among different socio-demographic characteristics that were assessed. The proportion of HIV-infection among HBsAg-positive pregnant women was 4.1% [95% CI: 2.5-6.3%]. The prevalence of HBV-HIV co-infection was higher among women aged 15-24 years compared to those women aged 25-49 years [aOR = 6.9 (95% CI: 1.8-27.0)]. Women residing in urban areas seemed having HBV-HIV co-infection compared with women residing in rural areas [aOR = 4.3 (95% CI: 1.2-16.4)]. Women with more than two pregnancies were potentially having the co-infection compared to those with two or less (aOR = 6.9 (95% CI: 1.7-27.8). Women with RPR-positive test were seemed associated with HBV-HIV co-infection (aOR = 24.9 (95% CI: 5.0-122.9).


CONCLUSION
Chronic HBV infection is a public health problem among pregnant women in Rwanda. Understanding that HBV-HIV co-infection may be more prominent in younger women from urban residences will help inform and strengthen HBV prevention and treatment programmes among HIV-infected pregnant women, which is crucial to this population.
['Mutagoma|Mwumvaneza|M|', 'Balisanga|Helene|H|', 'Malamba|Samuel S|SS|', 'Sebuhoro|Dieudonné|D|', 'Remera|Eric|E|', 'Riedel|David J|DJ|', 'Kanters|Steve|S|', 'Nsanzimana|Sabin|S|']
D000293:Adolescent D000328:Adult D060085:Coinfection D003430:Cross-Sectional Studies D005260:Female D015658:HIV Infections D006514:Hepatitis B Surface Antigens D019694:Hepatitis B, Chronic D006801:Humans D008875:Middle Aged D011247:Pregnancy D011251:Pregnancy Complications, Infectious D015995:Prevalence D012432:Rwanda D018571:Sentinel Surveillance D055815:Young Adult
Hepatitis B virus HIV Pregnant women HIV-HBV co-infection