A Cross Sectional Study on the Bidirectional Interactions Between Leptospirosis and HIV Infection Among Patients from Maputo Central Hospital, Mozambique.

Introduction: This study aims to determine the baseline seroprevalence of leptospirosis, a zoonotic and neglected disease, in people living with HIV (PWH) in Maputo, Mozambique, and to evaluate the relationship between selected HIV-related factors that might influence risk of coinfection with leptospirosis, such as degree of immunosuppression, as assessed by CD4 cell count, World Health Organization (WHO) HIV/AIDS clinical stage and antiretroviral therapy (ART) intake. Methods: This was a descriptive cross-sectional analysis of 157 PWH, aged over 18 years old, admitted to the Maputo Central Hospital, in Maputo, Mozambique, between March 2020 and October 2021. The study participants were recruited as a convenience sample regardless of the reasons for their admission. We collected sociodemographic and clinical data, including ART and WHO HIV/AIDS clinical stage, and blood for CD4 cell count and detection of Leptospira IgG antibodies using a commercial Kit ab247199 Leptospira IgG ELISA (www.abcam.com/ab247199) with sensitivity and specificity of 100% and 97.3%, respectively. Laboratory testing was performed at the Faculty of Medicine, Eduardo Mondlane University and Laboratory of Clinical Analysis, in Maputo. Results: Participants were aged 18 to 72 years (median age 39 years; SD ± 10.5), the majority were female 100 (63.7%), from urban areas 138 (87.9%), with secondary-level education 80 (51%). The overall seroprevalence of Leptospira IgG antibodies was 40.1%. The median CD4 cell count was 385 cells/µl (02 to 2297; SD ± 378.47). Higher seroprevalence of Leptospira antibodies was found among participants with CD4 cell counts <250 cells/µl (54.8%), WHO HIV/AIDS stage IV (70.2%) and those on ART (92%), though there were no statistically significant differences between groups with and without Leptospira antibodies. Conclusion: Our study confirmed that Leptospira antibodies are highly prevalent in PWH in Maputo; however, Leptospira infection was not associated with the degree of immunosuppression, WHO HIV/AIDS clinical stage, or the use of ART. Our data support the need for routine screening for leptospirosis in PWH in Mozambique. Future studies are warranted to characterize the incidence and outcomes of symptomatic leptospirosis in this patient population and to identify circulating serovars and species in the country and region, as well as the implicated reservoirs.

First report of occult hepatitis B infection among ART naïve HIV seropositive individuals in Maputo, Mozambique.

BACKGROUND: The prevalence of hepatitis B virus (HBV) infection and human immunodeficiency virus (HIV) infection in Mozambique is one of the highest in the world, though in spite of this the prevalence of occult hepatitis B infection (OBI) is unknown. OBJECTIVES: This study was conducted with the aim to investigate the prevalence of OBI and frequency of isolated hepatitis B core antibody (anti-HBc alone) among antiretroviral (ART) naïve HIV-positive patients in Mozambique. METHODS: A cross-sectional study was conducted in two health facilities within Maputo city. All ART-naive HIV seropositive patients attending outpatient clinics between June and October 2012 were consecutively enrolled. Blood samples were drawn from each participant and used for serological measurement of HBV surface antigen (HBsAg), antibodies against HBV surface antigen (anti-HBs) and antibodies against core antigen (anti-HBc) using ELISA. Quantification of HBV DNA was performed by real time PCR. A questionnaire was used to obtain demographics and clinical data. RESULTS: Of the 518 ART-naive HIV-positive subjects enrolled in the study, 90.9% (471/518) were HBsAg negative. Among HBsAg negative, 45.2% (213/471) had isolated anti-HBc antibodies, and the frequency of OBI among patients with anti-HBc alone was 8.3% (17/206). OBI was not correlated either with CD4+ T cells count or transaminases levels. A total of 11.8% of patients with OBI presented elevated HBV DNA level. Frequency of individuals with APRI score > 2 and FIB-4 score > 3.25 was higher in patients with OBI as compared not exposed, immune and anti-HBc alone patients. CONCLUSION: Our data demonstrate for the first time that OBI is prevalent among HIV patients in Mozambique, and will be missed using the commonly available serological assays that measures HBsAg.

Correction: HBV infection in untreated HIV-infected adults in Maputo, Mozambique.

[This corrects the article DOI: 10.1371/journal.pone.0181836.].

HBV infection in untreated HIV-infected adults in Maputo, Mozambique.

BACKGROUND: HIV/ HBV coinfected patients are at high risk of developing chronic HBV infection, liver cirrhosis and hepatocellular carcinoma. In Mozambique, where HIV prevalence is one of the highest in the world, HIV-infected patients are scarcely characterized in terms of HBV coinfection and 3TC-resistance mutations profile. METHODS: To characterize ART-naïve HIV-infected adults, with and without HBV coinfection, a cross-sectional study was conducted between May and November 2012 in two health centers from Maputo city, Mozambique. Subjects were consecutively enrolled in the study and, then, tested for hepatitis B surface antigen (HBsAg). Moreover, CD4+ T cells count, HBV DNA in plasma, HBV genotyping and 3TC-resistance mutations profile of HBV were assessed in HIV/HBV coinfected patients. RESULTS: In total, 518 patients were enrolled in the study. The median age was 33 years old and 66.8% were women. The median CD4+ T cells count was 361 cells/mm3 and 47 (9.1%) were coinfected with HBV. Out of 46 coinfected patients, 24 (55.2%) had HBV DNA ≥ 20 - < 20 000 and 12 (26.1%) had HBV-DNA ≥20 000. APRI > 2.0 was reported in 4.3% of coinfected and 1.7% of monoinfected patients (p = 0.228), while FIB-4 > 3.25 was reported in 4.4% of coinfected and 1.3% of monoinfected patients (p = 0.112). Genotype A was the most frequent, identified in 25/27 (92.6%) patients, whereas genotype E was present in 2/27 (7.4%) patients. No patient had 3TC-resistance mutations. CONCLUSIONS: This study showed that HBV coinfection was prevalent among ART-naïve HIV-infected adults in Mozambique. Overall, these data highlight the importance of screening HBV coinfection as an integrated measure of HIV routine care to improve health conditions and treatment of HIV/HBV coinfected patients.

Infecção oculta por vírus da hepatite B em doentes com anti-HBc isolado e coinfecção por vírus da imunodeficiência humana, Maputo, Moçambique / Occult hepatitis B virus infection in patients with isolated anti-HBc and human immunodeficiency virus co-infection, Maputo, Mozambique

Na África subsariana, a prevalência da infecção por vírus da hepatite B (VHB) varia entre 9-20% e da coinfecção VHB/vírus da imunodeficiência humana (VIH), entre 10-20%. VHB tem a patogénese centrada na resposta imunitária e VIH tem impacto na infecção por VHB por induzir maior risco de cronicidade e por acelerar a progressão da doença hepática. Por outro lado, a imunodepressão causada por VIH pode condicionar que a infecção por VHB seja, apenas, detectada pela positividade da carga vírica, com AgHBs negativo, o que se denomina de hepatite B oculta. A prevalência da infecção oculta por VHB é desconhecida em infectados por VIH, em Moçambique. Metodologia Em infectados por VIH, com AgHBs negativo, foi feito o estudo no soro do anti-HBs e anti-HBc, usando técnicas imunoenzimáticas. Nas amostras com anti-HBc isolado foi feita a avaliação da infecção oculta por VHB, definida por níveis de ADN de VHB ≥ 20 UI / mL, usando o teste Cobas Ampliprep / Cobas TaqMan HBV 96, versão 2.0 (Roche Diagnostics, Alemanha). O protocolo do estudo foi aprovado pelo Comité Nacional de Bioética para Saúde. Resultados Dos 518 infectados por VIH, 471 (90,9%) eram AgHBs negativo e, destes, 213 (45,2%) tinham anti-HBc total, isoladamente, positivo. A hepatite B oculta foi identificada em 17 (8,2%) destes indivíduos. Conclusões Em Moçambique o risco de hepatite B oculta é de 8,2% em coinfectados por VIH o que pode ter implicações na prática clínica, em particular no que diz respeito à terapêutica da infecção por VIH, dando preferência por regimes que incluam dois fármacos activos contra VHB.

The prevalence of occult hepatitis B in Mozambique is unknown. Nevertheless, coinfection with HBV/HIV is endemic in Sub-Saharan Africa. It is responsible for rising morbidity related to chronic liver disease as well as thousands of deaths. National Health Policies don't cater for routine testing for the presence of HBV in HIV-positive patients, making the assessment for cases of co-infection challenging. The aim of this study is to evaluate the prevalence of occult hepatitis B as well as the isolated core antibody in HIV-positive patients, the factors associated in cases of co-infection, and the clinical and laboratorial correlations between occult hepatitis B and HIV in Mozambique. Methodology In this study, patient demographics and clinical data were collected from five hundred and eighteen HIV-positive patients, between June and October 2012, at two Health Centers in Maputo. Serological tests using ELISA were conducted to determine the presence of HBVAg, anti-HBs and anti-HBc, as well as the Cobas Ampliprep/Cobas TaqMan HBV 96, version 2.0 (Roche Diagnostics, Germany) for DNA sequencing. The study has ethical approval from the National Bioethics Committee for Health of Mozambique. Results Four hundred and seventy-one serum samples (90,9%) were HBsAg negative and, of those, 213 (45,2%) were isolated anti-HBc positive. From these occult Hepatitis B was identified in 17 samples (8,2%). Conclusions We found a high prevalence of isolated anti-HBc and occult hepatitis B infection with low levels of DNA viral load (64,7% between 20-100UI/mL). These results shows that we need to use, preferably, therapeutic regimes that include two drugs with double action against HIV and HBV

Simultaneous presentation of Kaposi sarcoma and HHV8-associated large B-cell lymphoma in the same lymph node: A rare diagnosis in an HIV-negative patient.

PATIENT: Female, 18 FINAL DIAGNOSIS: Simultanous presentation of Kaposi Sarcoma and Lymphoma Symptoms: - MEDICATION: - Clinical Procedure: - Specialty: Oncology. OBJECTIVE: Rare disease. BACKGROUND: KSHV/HHV-8 is associated with Kaposi's sarcoma (KS) as well as with a few categories of lymphoproliferative diseases, mostly occurring in patients with HIV infection/AIDS. Although the association between lymphomas and Kaposi's sarcoma has been described, the simultaneous presence of the 2 entities within the same organ is rare and mainly associated with HIV/ AIDS. CASE REPORT: We report a case of simultaneous occurrence of Kaposi's sarcoma and large B-cell lymphoma in the same lymph node in a 18-year-old African woman who was HIV-negative. We found concurrent infection with Kaposi's sarcoma herpes virus (KSHV) and Epstein-Barr virus (EBV), confirmed by PCR amplification of DNA obtained from distinct tumor areas selected in the paraffin block. CONCLUSIONS: The possibility of occurrence of 2 lesions with distinct features in the same organ may be unexpected for pathologists performing fine-needle aspiration cytology (FNAC) evaluation but must be considered, even in HIV-negative individuals, despite its rare occurrence, as was demonstrated by this case.