HIV-HBV Co-infections in Central India: Prevalence, Clearance Rates, and Long-term Outcomes from a Decade of Experience at a Tertiary Care Center

Two of the most infamous viruses, the Human immunodeficiency virus (HIV) and hepatitis B virus (HBV) have similar transmission routes. Consequently, some individuals might get co-infected with both viruses resulting in increased deaths and prolonged disease. Even among healthy (Non-immunocompromised) persons, chances of getting persistent HBV infection are 5-10%, however among persons harboring HIV, HBV the persistence rates might escalate up to 15 %. Such increased suffering might occur despite the longevity provided by starting highly active anti-retroviral therapy (HAART), which is the current standard treatment. Our pioneering study, in our region aims to assess the prevalence of HIV-HBV co-infection, clearance rates of HBV, demographic characteristics of affected individuals, and long-term outcomes. By shedding light on these aspects, we hope to gain valuable insights into the impact of such co-infections and pave the way for better management and care of individuals facing this dual challenge. We studied 1808 persons enrolled for HIV treatment from amongst 170,019 persons screened. Higher co-infection of HIV-HBV was observed in males as compared to females, with the age group of 31-40 years being most affected. The most common route of infection, was heterosexual contact accounting for 86% of cases, accounting for majority co-infections. Over the years, we noticed a decline in the number of HIV-HBV co-infected cases, with the nadir occurring in 2015. Seroprevalence of co-infections was 2.37%, but despite this observed low sero-prevalence HBV clearance was relatively poor among the co-infected, as only 4 (9.3%) able to clear the infection after initiation of HAART. Our study highlights that chances of HBV clearance among the co-infected are worse than that observed among otherwise heathy populations thus also highlighting the urgent need for universal HBV vaccination in all HIV-affected persons, underscoring the importance of providing special attention to them. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The review and analysis work was performed after obtaining due approval from the institutional human ethics committee at Bundelkhand Govt. Medical College and Hospital, approval number IECBMC/2020/10. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors. * ALT : Alanine aminotransferase ART : Anti-retroviral therapy AST : Aspartate aminotransferase ALK : Alkaline phosphatase CD4 : Cluster of differenciation 4 HAART : Highly active anti-retroviral therapy HbeAg : Hepatitis B envelope antigen HBcAg : Hepatitis B core antigen HBV : Hepatis B virus HCV : Hepatitis C virus HIV : Human immunodeficiency virus MHC : Major histocompatibility complex MSM : Male having sex with male NACO : National AIDS control organization PCR : Polymerase chain reaction S bil : Serum bilirubin