Jacobs B, Mayaud P, Changalucha J, Todd J, Ka-Gina G, Grosskurth H, Berege Z A
LIVOS Project, Mwanza, Tanzania.
Sex Transm Dis. 1997 Mar;24(3):121-6. doi: 10.1097/00007435-199703000-00001.
Hepatitis B virus (HBV) is endemic and poses a grave public health problem in Africa where it is mainly transmitted from mother to baby or during childhood. Sexual transmission has also been suggested to play a role in East Africa, but this has never been properly demonstrated. Additional preventive strategies may be proposed if sexual transmission of HBV occurred in this region where HIV and other STDs are highly prevalent.
To determine the prevalence of markers for hepatitis B virus (HBV)and other sexually transmitted diseases (STD) in routine blood samples taken from three populations in Mwanza, Tanzania, and to use the data collected to look at the association between hepatitis B and other STDs, including human immunodeficiency virus (HIV).
Routine blood samples were collected from 1,025 patients attending a clinic for STDs, 253 voluntary blood donors from secondary schools, and 952 blood donors who gave blood in a hospital specifically for a relative who needed a blood transfusion. All samples were tested for HIV by double enzyme-linked immunosorbent assay (ELISA), and for syphilis using the Treponema pallidum hemagglutination (TPHA) and rapid plasma reagin (RPR) tests. Two markers for HBV were examined by the double ELISA method, the presence of the anti-hepatitis B core antigen (anti-HBc) and the hepatitis B surface antigen (HBsAg).
There were high prevalences of HBV, syphilis, and HIV in relative donors and STD patients. Although HBV markers were more prevalent in men of increasing ages, syphilis and HIV markers were more prevalent in young women. Evidence of past infection with HBV (presence of anti-HBc) was associated with serologic markers of recent treponemal infection (both TPHA and RPR positive) in both sexes (men odds ratio [OR] = 1.91, P < 0.011; women OR = 2.34, P < 0.02) and with HIV in men (OR = 1.93, P < 0.003). Current infection with HBV (presence of HBsAg) was associated with recent syphilis in men (OR = 2.13, P < 0.006). In STD patients, current infection with HBV was associated with Trichomonas vaginalis in women (OR = 3.57, P < 0.002) and recent syphilis in men (OR = 3.46, P < 0.001). There was no further association between HBV markers and any other STD pathogen or any particular STD syndrome, nor was there any association between current HBV infection and HIV in both sexes. The population attributable fraction for sexual acquisition of hepatitis B is estimated at 7.2% in men and 3.0% in women, based on the association between hepatitis B and syphilis.
These findings suggest that sexual acquisition of hepatitis B occurs at low levels in Mwanza, and that HBV can be prevented through enhancement of the current HIV/STD control activities, in addition to improved vaccination strategies.
乙型肝炎病毒（HBV）在非洲呈地方性流行，是一个严重的公共卫生问题，在非洲主要通过母婴传播或儿童期传播。在东非，也有人认为性传播起了一定作用，但从未得到充分证实。如果在这个艾滋病毒和其他性传播疾病高度流行的地区发生HBV性传播，可能会提出其他预防策略。
确定在坦桑尼亚姆万扎三个群体的常规血液样本中乙型肝炎病毒（HBV）和其他性传播疾病（STD）标志物的流行率，并利用收集到的数据研究乙型肝炎与其他性传播疾病（包括人类免疫缺陷病毒（HIV））之间的关联。
从1025名到性病门诊就诊的患者、253名来自中学的自愿献血者以及952名专门为需要输血的亲属在医院献血的献血者中采集常规血液样本。所有样本均采用双酶联免疫吸附试验（ELISA）检测HIV，采用梅毒螺旋体血凝试验（TPHA）和快速血浆反应素试验（RPR）检测梅毒。采用双ELISA法检测HBV的两种标志物，即抗乙型肝炎核心抗原（抗-HBc）和乙型肝炎表面抗原（HBsAg）的存在情况。
在亲属献血者和性病患者中，HBV、梅毒和HIV的流行率很高。虽然HBV标志物在年龄较大的男性中更为普遍，但梅毒和HIV标志物在年轻女性中更为普遍。既往感染HBV的证据（抗-HBc阳性）在男女中均与近期梅毒螺旋体感染的血清学标志物（TPHA和RPR均阳性）相关（男性比值比[OR]=1.91，P<0.011；女性OR=2.34，P<0.02），在男性中与HIV相关（OR=1.93，P<0.003）。当前感染HBV（HBsAg阳性）在男性中与近期梅毒相关（OR=2.13，P<0.006）。在性病患者中，当前感染HBV在女性中与阴道毛滴虫相关（OR=3.57，P<0.002），在男性中与近期梅毒相关（OR=3.46，P<0.001）。HBV标志物与任何其他性传播疾病病原体或任何特定性传播疾病综合征之间没有进一步关联，当前HBV感染与男女中的HIV之间也没有关联。根据乙型肝炎与梅毒之间的关联，估计男性因性传播感染乙型肝炎的人群归因分数为7.2%，女性为3.0%。
这些发现表明，在姆万扎，通过性传播感染乙型肝炎的情况较少，除了改进疫苗接种策略外，还可以通过加强当前的艾滋病毒/性传播疾病控制活动来预防HBV。
