Mutagoma Mwumvaneza, Balisanga Helene, Malamba Samuel S, Sebuhoro Dieudonné, Remera Eric, Riedel David J, Kanters Steve, Nsanzimana Sabin
Rwanda Biomedical Center, Ministry of Health, P.O. Box: 7162, Kigali, Rwanda.
US Centers for Disease Control and Prevention (CDC), Center for Global Health (CGH), Division of Global HIV/AIDS (DGHA), Kigali, Rwanda.
BMC Infect Dis. 2017 Sep 11;17(1):618. doi: 10.1186/s12879-017-2714-0.
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.
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.
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).
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.
乙型肝炎病毒（HBV）影响着全球各地的人们，但当地的负担情况，尤其是在孕妇及其新生儿中的负担情况尚不清楚。在卢旺达，同时感染了HBV的艾滋病毒感染者应立即开始接受抗逆转录病毒治疗。HBV在分娩期间很容易从母亲传播给孩子。我们试图估计卢旺达产前诊所（ANC）就诊的孕妇中慢性HBV感染的患病率，并确定与HBV和HIV合并感染相关的因素。
本研究采用横断面调查，以哨点地区的孕妇为目标人群。对孕妇进行了乙型肝炎表面抗原（HBsAg）和HIV感染检测。进行了一系列检测以确保高灵敏度。多变量逻辑回归用于确定在ANC哨点监测期间收集的人群中HBV-HIV合并感染的独立预测因素，这些因素包括：年龄、婚姻状况、教育水平、职业、居住地、妊娠情况和梅毒感染情况。
在13121名孕妇中，HBsAg的患病率为3.7%（95%置信区间：3.4-4.0%），在评估的不同社会人口学特征中患病率相似。HBsAg阳性孕妇中的HIV感染比例为4.1%[95%置信区间：2.5-6.3%]。15-24岁的女性中HBV-HIV合并感染的患病率高于25-49岁的女性[aOR = 6.9（95%置信区间：1.8-27.0）]。与农村地区的女性相比，居住在城市地区的女性似乎更容易发生HBV-HIV合并感染[aOR = 4.3（95%置信区间：1.2-16.4）]。与怀孕两次或更少的女性相比，怀孕超过两次的女性更有可能发生合并感染（aOR = 6.9（95%置信区间：1.7-27.8）。梅毒快速血浆反应素环状卡片试验（RPR）呈阳性的女性似乎与HBV-HIV合并感染有关（aOR = 24.9（95%置信区间：5.0-122.9）。
慢性HBV感染是卢旺达孕妇中的一个公共卫生问题。认识到HBV-HIV合并感染在城市地区的年轻女性中可能更为突出，将有助于为艾滋病毒感染孕妇的HBV预防和治疗计划提供信息并加强该计划，这对这一人群至关重要。
