Background: Hepatitis B virus (HBV) infection is a major cause of morbidity and mortality; however, little is known about the prevalence and distribution of HBV in some populations and regions.
Methods: A total of 9791 participants, 15-49 years old, were enrolled in a household survey in KwaZulu-Natal, South Africa. Peripheral blood samples were tested for markers of HBV (hepatitis B surface antigen (HBsAg), hepatitis B e antigen (HBeAg), antibody to HBeAg (anti-HBe)) and analysed, accounting for multilevel sampling and weighted to represent the population.
Results: Overall HBsAg prevalence was 4.0% (95% confidence interval (CI) 3.4-4.5%): 4.8% (95% CI 3.8-5.8%) in men and 3.2% (95% CI 2.5-3.9%) in women (p=0.01). Among HBsAg-positive participants, 35.2% (95% CI 29.2-41.2%) were HBeAg-positive and 66.3% (95% CI 60.1-72.4%) were anti-HBe-positive. HBsAg prevalence was 6.4% (95% CI 5.3-7.5%) among HIV-positive participants compared to 2.6% (95% CI 1.9-3.2%) among HIV-negative participants (p<0.01), and was higher among HIV-positive men (8.7%, 95% CI 6.3-11.2%) than among HIV-positive women (5.0%, 95% CI 3.8-6.2%) (p<0.01).
Conclusions: HBV infection among HIV-positive men remains an important public health problem in communities in KwaZulu-Natal, South Africa. The prevalence of HBsAg and HBeAg highlight the importance of surveillance and an important missed opportunity for the scale-up of programmes to achieve the goal of controlling HBV for public health benefit.
Keywords: Anti-HBe; HBV–HIV co-infection; HBeAg; HBsAg; Hepatitis B virus (HBV) prevalence; South Africa.
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