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Abstract Background HIV and hepatitis B virus (HBV) prevalence are high in KwaZulu-Natal, South Africa. HIV co-infection negatively impacts HBV prognosis, and can increase likelihood of HBV mother-to-child-transmission (MTCT). In an early HIV infant treatment intervention cohort of HIV-transmitting mother-child pairs in KwaZulu-Natal, we characterised maternal HBV prevalence, and screened at-risk infants. Methods Infants were treated for HIV MTCT at birth, and combination regimens incidentally active against HBV were initiated within 21 days. Maternal samples (n = 175) were screened for HBV infection (HBsAg), exposure to HBV (anti-HBc) and vaccination responses (anti-HBs-positive without other HBV markers) at birth. Infants of HBV-positive mothers were screened for HBsAg at 1 and 12 months. Results Evidence of HBV infection was present in 8.6% (15/175) of maternal samples. Biomarkers for HBV exposure were present in 31.4% (55/175). Evidence of HBV vaccination was uncommon in mothers (8.0%; 14/175). Despite prescription of antiretroviral therapy (ART) active against HBV, HBV DNA was detectable in 46.7% (7/15) HBsAg-positive mothers. Three mothers had HBV viral loads >5.3log10 IU/ml, making them high-risk for HBV MTCT. Screening of available infant samples at one month (n = 14) found no cases of HBV MTCT. At 12 months, we identified one HBV infection (1/13) and serological evidence of vaccination was present in 53.8% (7/13) infants. Discussion This vulnerable cohort of HIV-transmitting mothers had a high undiagnosed HBV prevalence. Early infant ART may have reduced risk of MTCT in high-risk cases. Current HBV guidelines recommend ART prophylaxis but these data underline the pressing need to increase availability of birth dose vaccines.

Original publication




Journal article


Open Forum Infectious Diseases


Oxford University Press (OUP)

Publication Date