Hepatitis B virus (HBV) and human immunodeficiency virus (HIV) co-infection is a significant global health concern due to their shared transmission routes, such as blood, sexual contact, and from mother to child during birth. HBV is a DNA virus that infects the liver, leading to both acute and chronic liver diseases, including cirrhosis and hepatocellular carcinoma. HIV is an RNA virus that targets the immune system, specifically CD4+ T cells, leading to immune deficiency and increased vulnerability to opportunistic infections and certain cancers. The coexistence of these two viruses, known as HIV-HBV co-infection, exacerbates the health outcomes of the affected individuals, causing more severe disease progression and complications than either infection alone [1].

The prevalence of HBV among HIV-infected individuals varies significantly across different regions. Studies have shown that in some areas, up to 10% of HIV-positive individuals are also infected with HBV [2]. In the African continent, particularly sub-Saharan Africa, the prevalence of HIV/HBV co-infection is notably high due to the endemic nature of both viruses. For instance, a study conducted in Turkey reported that 6.1% of HIV-positive individuals were co-infected with HBV, while in Brazil, the prevalence ranged from 3.1% to 6.1% depending on the region and population studied [3]. These variations highlight the need for region-specific studies to understand the local epidemiology of HIV-HBV co-infection better and to develop targeted public health interventions [4].

Co-infection with HBV and HIV leads to more severe health outcomes compared to mono-infection with either virus. HIV infection accelerates the progression of HBV-related liver disease, increasing the risk of liver cirrhosis, hepatocellular carcinoma, and liver-related mortality. Conversely, HBV infection can complicate the management of HIV due to potential drug interactions and the necessity for specific antiviral therapies that target both viruses. The immunosuppressive nature of HIV also makes it harder for the body to control HBV infection, leading to higher rates of chronic HBV and increased liver damage. Additionally, co-infected individuals may experience higher levels of HBV replication, further exacerbating liver disease and complicating treatment regimens [5-6].

The Gwalior region, like many other parts of India, faces a significant burden of both HIV and HBV infections. Despite the high prevalence of these infections, there is a lack of comprehensive data on the prevalence and impact of HBV co-infection among HIV-positive individuals in this region. This study aims to fill this gap by providing detailed epidemiological data, which is crucial for several reasons. Co-infection necessitates tailored treatment strategies that address both infections, optimizing patient outcomes and reducing liver-related complications. Understanding the prevalence and characteristics of co-infection will help healthcare providers develop more effective treatment plans that consider the unique needs of co-infected patients [7-8].

This cross-sectional study is conducted in the Department of General Medicine, G.R. Medical College, Gwalior (M.P.) at ART Centre after taking informed consent from the patients.

INCLUSION CRITERIA:

• All newly diagnosed adult patient (18-60 years) of HIV who will be visiting ART center at OPD of Jayarogya Group of Hospital, Gwalior for 01 Year.

EXCLUSION CRITERIA:

• Patients infected with Hepatitis other than Hepatitis B.
• Pregnant women and children age less than 18 years
• HIV negative patient

Patient is selected for our study on the basis of all inclusion criteria. All patients were explained and informed about the study before the start of data collection. Informed consent was taken and details of the patient recorded. Patient demographic details viz age, sex, residence, level of education are recorded along with height, weight and BMI which was recorded with correctly calibrated weighing machine. Patient laboratory data viz Hemoglobin, blood counts, liver function test, serum albumin, CD4 count were collected from the ART center present at Jayarogya Group of Hospital, Gwalior.

Table No. 1: Descriptive Statistics Distribution

The average Hb (Hemoglobin) level indicates the general anemia status among patients, suggesting that many may have lower than average Hb levels. The mean and standard deviation of TLC (Total Leukocyte Count) reflect variability in the immune response, indicating a range of immune function among the patients. The normal platelet counts observed suggest that most patients do not suffer from thrombocytopenia. The levels of AST and ALT, which are liver enzymes, fall within expected ranges, indicating that liver function is generally normal across the population. Lastly, the levels of S. Albumin provide insights into the nutritional and liver function status of the patients, showing that most have adequate protein levels. These statistics collectively help in understanding the overall health and potential complications in the study group.

Table No. 2: Distribution of Patients based on geographic location by Co-infection Status

The majority of patients are from rural areas, with 55.03% in the HIV-only group and 50.00% in the co-infected group. Urban patients make up 44.97% of the HIV-only group and 50.00% of the co-infected group. The p-value for this distribution is 0.87, indicating no significant difference in residence distribution between the groups.

Table No. 3: Marital Status Distribution of Patients by Co-infection Status

The majority of patients are married, with 66.48% in the HIV-only group and 94.44% in the co-infected group. Single patients account for 20.39% of HIV-only and 5.56% of co-infected patients. Divorced and widowed patients represent a small proportion. The p-value for this distribution is 0.03, indicating a significant difference in marital status distribution between the groups.

Table No. 4: Prevalence of Hepatitis B in HIV Patients (HIV& Hepatitis B Co-infection Distribution)

The prevalence of Hepatitis B co-infection among HIV patients. Out of 376 patients, 358 (95.21%) are HIV positive only, while 18 (4.79%) are co-infected with Hepatitis B. This indicates a relatively low prevalence of Hepatitis B among the HIV patients in the study population.

Table No. 5: Distribution of patients by Route of transmission in HIV and HIV Hep B Co infected patient

The most common route of transmission for both groups is heterosexual contact, with 75.14% in the HIV-only group and 55.56% in the co-infected group. Unsafe injection is notably higher in the co-infected group at 33.33%. The p-value for this distribution is 0.03, indicating a significant difference in transmission routes between the groups.

Table No. 6: CD4 Cell Count Distribution of Patients with HIV and HIV and Hep B Co-infection

The majority of patients have CD4 counts between 200-500, with 36.03% in the HIV only group and 61.11% in the co-infected group. The p-value for this distribution is 0.05, indicating a borderline significant difference in CD4 cell count distribution between the groups.

Table No. 7: High-Risk Occupation Distribution

The majority of patients have no high-risk occupations, with 79.33% in the HIV-only group and 77.78% in the co-infected group. Truck drivers represent a higher percentage in the co-infected group (16.67%). The p-value for this distribution is 0.54, indicating no significant difference in occupation distribution between the groups.

The descriptive statistics table presents the central tendencies and dispersion for Hemoglobin (Hb), Total Leukocyte Count (TLC), Platelet Count, AST, ALT, and Serum Albumin. The mean Hb level suggests a general anemia status among patients, while the TLC reflects variability in immune function [9]. Normal platelet counts indicate no widespread thrombocytopenia. AST and ALT levels are within expected ranges, indicating generally normal liver function. Serum Albumin levels suggest adequate nutritional and liver function status among the majority of patients. These statistics collectively offer a comprehensive view of the overall health and potential complications within the study population [10].

The age distribution table reveals that most patients fall within the 30-39 age group (30.32%) and the 40-49 age group (26.06%). The age range of 30-49 years accounts for a significant proportion of the patients, indicating a higher prevalence of HIV and Hepatitis B co-infection in middle-aged individuals. The p-value of 0.24471 suggests no significant difference in age distribution between the HIV-only and co-infected groups [11].

The residence distribution shows that the majority of patients are from rural areas, with 55.03% in the HIV-only group and 50.00% in the co-infected group. Urban patients constitute 44.97% of the HIV-only group and 50.00% of the co-infected group. The p-value of 0.87 indicates no significant difference in residence distribution between the groups.

Out of 376 patients, 358 (95.21%) are HIV positive only, while 18 (4.79%) are co-infected with Hepatitis B. The relatively low prevalence of Hepatitis B among HIV patients indicates that co-infection is not highly common in this population. The p-value of 0.725 suggests no significant difference in the distribution of co-infection status across the patient population [12].

The majority of patients have CD4 counts between 200-500, with 36.03% in the HIVonly group and 61.11% in the co-infected group. The p-value of 0.05 indicates a borderline significant difference in CD4 cell count distribution between the groups, suggesting that co-infection might affect immune status [13].

Lower CD4 counts were associated with higher rates of HBV co-infection. Zerdali et al. (2021) reported similar findings, consistent with our observations. Lo Re et al. (2019) also found that lower CD4 counts are significant determinants of liver complications in HIV/HBV co-infected patients [14].

The high-risk occupation distribution shows that the majority of patients have no highrisk occupations, with 79.33% in the HIV-only group and 77.78% in the co-infected group. Truck drivers represent a higher percentage in the co-infected group (16.67%). The p-value of 0.54 indicates no significant difference in occupation distribution between the groups.

Truck drivers had a higher percentage of co-infection. Lo Re et al. (2019) identified certain occupations as risk factors for HBV infection among HIV patients, supporting our findings (192) [15].

Significant differences were observed in haemoglobin levels, with lower levels indicating anaemia's impact on overall health in the co-infected group. Prevalence of Hepatitis B in HIV Patients (HIV & Hepatitis B Co-infection Distribution).

Firstly, the overall prevalence of Hepatitis B co-infection among HIV patients was found to be 4.79%, aligning with global trends and underscoring the ongoing need for vigilant monitoring and comprehensive care strategies. This relatively low prevalence also indicates the effectiveness of current prevention efforts, though it emphasizes the necessity for sustained and enhanced intervention programs. This study underscores the importance of continuous monitoring, targeted prevention, and comprehensive care strategies for HIV and Hepatitis B confected patients. The findings reinforce the need for integrated healthcare services that address the unique challenges faced by this vulnerable population.

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