Seroprevalence, seroconversion and mother-to-child-transmission of dual and triplex infection of HIV, hepatitis B and C viruses among pregnant women in Nigeria: A national cohort study

Abstract

George Uchenna Eleje^1,2*, Hadiza Abdullahi Usman^3,4; Preye Owen Fiebai^5,6; Ikechukwu Innocent Mbachu^1,2; Godwin Otuodichinma Akaba^7,8; Olabisi Morebise Loto^9,10; Ayyuba Rabiu^11,12; Chinyere Ukamaka Onubogu¹³, Moriam Taiwo Chibuzor¹⁴, Rebecca Chinyelu Chukwuanukwu¹⁵; Ngozi Nneka Joe-Ikechebelu^16,17; Chike Henry Nwankwo¹⁸; Stephen Okoroafor Kalu¹⁹; Chukwuanugo Nkemakonam Ogbuagu²⁰; Shirley Nneka Chukwurah²¹,  Chinwe Elizabeth Uzochukwu²²; Ijeoma Chioma Oppah⁵; Aishat Ahmed⁷; Richard Obinwanne Egeonu²; Harrison Chiro Ugwuoroko²; Chiamaka Henrietta Jibuaku²³; Samuel Oluwagbenga Inuyomi²⁴; Bukola Abimbola Adesoji²⁵; Ubong Inyang Anyang⁷; Uchenna Chukwunonso Ogwaluonye²³; Ekene Agatha Emeka²⁶; Odion Emmanuel Igue²⁷;  Ogbonna Dennis Okoro²⁸; Prince Ogbonnia Aja¹⁵;  Chiamaka Perpetua Chidozie¹⁵; Hadiza Sani Ibrahim¹³; Fatima Ele Aliyu¹³; Aisha Ismaila Numan¹¹; Solace Amechi Omoruyi⁵; Osita Samuel Umeononihu^1,2; Chukwuemeka Chukwubuikem Okoro², Ifeanyi Kingsley Nwaeju², Arinze Anthony Onwuegbuna²⁹, Eric Okechukwu Umeh³⁰,  Sussan Ifeyinwa Nweje³¹; Lydia Ijeoma Eleje³², Ifeoma Clara Ajuba³³; David Chibuike Ikwuka³⁴; Emeka Philip Igbodike³⁵;Chisom God’swill Chigbo³⁶; Uzoamaka Rufina Ebubedike³⁰; Nnaedozie Paul Obiegbu²; Chukwuemeka Okwudili Ezeama²; Ibrahim Adamu Yakasai^12,13; Oliver Chukwujekwu Ezechi³⁷;  Joseph Ifeanyichukwu Ikechebelu^1,2 and Triplex infection in pregnancy collaboration group^1-37

¹Department of Obstetrics and Gynecology, Nnamdi Azikiwe University, Awka, Nigeria.

²Department of Obstetrics and Gynecology, Nnamdi Azikiwe University Teaching Hospital, PMB 5025, Nnewi, Anambra State, Nigeria.

³Department of Obstetrics and Gynecology, University of Maiduguri, Maiduguri, Nigeria.

⁴Department of Obstetrics and Gynecology, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria.

⁵Department of Obstetrics and Gynecology, University of Port Harcourt, Port Harcourt, Nigeria.

⁶Department of Obstetrics and Gynecology, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria.

⁷Department of Obstetrics and Gynecology, University of Abuja, Abuja, Nigeria.

⁸Department of Obstetrics and Gynecology, University of Abuja Teaching Hospital, Abuja, Nigeria.

⁹Department of Obstetrics and Gynecology, Obafemi Awolowo University, Ile Ife, Nigeria.

¹⁰Department of Obstetrics and Gynecology, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria.

¹¹Department of Obstetrics and Gynecology, Bayero University, Kano, Nigeria.

¹²Department of Obstetrics and Gynecology, Aminu Kano Teaching Hospital, Kano, Nigeria.

¹³Department of Paediatrics, Nnamdi Azikiwe University, Awka, Nigeria.

¹⁴Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching hospital, Calabar, Nigeria.

¹⁵Immunology Unit, Department of Medical Laboratory Science, Nnamdi Azikiwe University, Awka, Nigeria.

¹⁶Department of Community Medicine and Primary Health Care, Faculty of Medicine, Chukwuemeka Odumegwu Ojukwu University Amaku-Awka, Nigeria

¹⁷Social Dimensions of Health Program (INTD), School of Public Health and Social Policy, Faculty of Human and Social Development, University of Victoria, British Columbia;

¹⁸Department of Statistics, Nnamdi Azikiwe University, Awka, Nigeria.

¹⁹HIV Care Laboratory/HIV Care Department, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria.

²⁰Department of Medical Microbiology and Parasitology, Faculty of Medicine, Nnamdi Azikiwe University, Awka, Nigeria.

²¹Gastroenterology Unit, Department of Medicine, Faculty of Medicine, Nnamdi Azikiwe University, Awka, Nigeria.

²²Department of Mass Communication, Nnamdi Azikiwe University, Awka, Nigeria.

²³Department of Pharmaceutical Sciences, Nnamdi Azikiwe University, Awka, Nigeria.

²⁴Department of Physics and Engineering Physics, Obafemi Awolowo University, Ile-Ife, Nigeria.

²⁵Department of Nursing, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria.

²⁶Department of Family Medicine, Faculty of Medicine, Nnamdi Azikiwe University, Awka, Nigeria.

²⁷Department of Physiological Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria.

²⁸Department of Parasitology & Entomology, Faculty of Veterinary Medicine, University of Maiduguri Borno State, Maiduguri, Nigeria.

²⁹Department of Ophthalmology, Nnamdi Azikiwe University, Awka, Nigeria.

³⁰Department of Radiology, Faculty of Medicine, Nnamdi Azikiwe University, Awka, Nigeria.

³¹Department of Nursing, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria

³²Measurement, Evaluation and Research Unit, Department of Educational Foundations, Nnamdi Azikiwe University, Awka, Nigeria.

³³Department of Haematology, Faculty of Medicine, Nnamdi Azikiwe University, Awka, Nigeria.

³⁴Department of Human Physiology, Nnamdi Azikiwe University, Awka, Nigeria.

³⁵Department of Obstetrics and Gynecology, St Georges Hospital Memorial Centre, 6 Rasheed Alaba Williams Street, Lekki Phase 1, Lagos, Nigeria.

³⁶Department of Applied Microbiology, Nnamdi Azikiwe University, Awka, Nigeria.

³⁷Nigerian Institute of Medical Research, Lagos, Nigeria.

ABSTRACT

Objectives: To evaluate the seroprevalence, seroconversion, and mother-to-child transmission (MTCT) rates for dual and triplex infections of HIV, hepatitis B, and hepatitis C virus among pregnant women in Nigeria. Methods: A multicentre prospective cohort study was conducted in six tertiary hospitals randomly selected from the six geopolitical zones of. All eligible consenting pregnant women were tested at recruitment for HIV, Hepatitis B, and C virus infections. Those positive for at least two of the infections in any combination were followed up. Those negative for the three infections or positive for only one of the infections at recruitment were retested at delivery.  Positive tests were confirmed using the PCR technique. The primary outcome measures were seroprevalence, seroconversion, and MTCT rates.  Data were managed with SPSS for windows version 23, with primary outcomes analyzed as % and 95% CIs. Ethical approval was obtained from NHREC (NHREC/01/01/2007-23/01/2020). Results: Of 2,775 participants enrolled, 13 (0.47%; 95% CI, 0.25% to 0.80%) and 4 (0.14%; 95% CI, 0.04% to 0.37%) were seropositive to dual and triplex infections, respectively. Of the 13 participants ‘seropositive to dual infections, 6 (46.15%; 95% CI, 16.94% to 100.46%) were seropositive to HIV and HBV, 4 (30.77%; 95% CI, 8.38% to 78.78%) were seropositive to HIV and HCV and 3 (23.08%; 95% CI, 4.76% to 67.44%) were seropositive to HBV and HCV. However, 2403 out of 2775 (86.59%; 95% CI, 83.17% to 90.13%) participants were followed up till delivery. Of the 2403 participants followed up, 2,386 did not have dual or triplex infection at enrolment. Of these 2,386, 3 participants were seropositive for dual infection of HIV and HBV at repeat testing at delivery, giving a seroconversion rate of 0.13% (95% CI, 0.03% to 0.36%). No participant had seroconversion for HIV-HCV or HBV-HCV or for triplex infections.  The MTCT rate was 0.0% for dual and triplex infections. Conclusion: We observed relatively high seroprevalence rates for dual and triplex infections of HIV, hepatitis B, and hepatitis C viruses in Nigeria but a low seroconversion and zero MTCT rates. Funding: TETFund National Research Fund 2019 (Grant number TETFund/DR&D/CE/NRF/STI/33).