BMC Infect Dis. 2026 May 4. doi: 10.1186/s12879-026-13454-9. Online ahead of print.
ABSTRACT
INTRODUCTION: Hepatitis B virus (HBV) coinfection worsens HIV care outcomes and liver disease risk, but genotype-specific data in the World Health Organization (WHO) Africa Region is limited. To address this gap, we assessed HBV genotype distribution and genotype-specific clinical features in a cohort of people living with HIV (PLHIV) in Maputo City, Mozambique.
METHODS: This was a sub-analysis of a prospective cohort study that included newly diagnosed, HIV/HBV coinfected patients who were enrolled from May 2021 to November 2023. DNA extraction and partial-genome nested PCR with Sanger sequencing was performed on plasma samples. HBV genotypes were assigned by BLASTn, Geno2pheno, HBVdb, and NCBI-HBV, and phylogeny was inferred with MAFFT-based alignments and maximum likelihood-based phylogenetics. Clinical/laboratory data (Hepatitis B e antigen, HBV viral load, aspartate aminotransferase, alanine aminotransferase, CD4+ T cell count, HIV viral load) were recorded. Fibrosis was estimated using the AST-Platelet Ratio Index (APRI) score and WHO thresholds. R was applied for statistical analyses. Group comparisons used Pearson’s chi-squared or Fisher’s exact and Wilcoxon rank sum tests (complete-case analysis).
RESULTS: Of 1,106 newly diagnosed ART-naïve PLHIV, 81 (7.3%) were hepatitis B surface antigen (HBsAg)-positive and genotyping was successful in 55 (68%). Among HBV genotyped patients, the median age was 33.0 years (IQR 30.0, 39.0), 37 (67.3%) were male, 46 (83.6%) had HBV genotype A (subgenotype A1) and 9 (16.4%) genotype E. Median AST, ALT, and APRI scores tended to be higher in genotype E than subgenotype A1 cases, although differences were not statistically significant (AST 71.9 vs. 37.9 U/L; IQR 26.0-118.0 vs. 29.0-98.1; ALT 36.5 vs. 32.6 U/L; IQR 20.4-63.0 vs. 20.2-57.7; APRI 1.3 vs. 0.5; IQR 0.3-1.8 vs. 0.3-1.3). HBV DNA > 2,000 IU/mL occurred in 52.2% of subgenotype A1 and 55.6% of genotype E cases. Most cases were HBeAg-negative (A1: 36/46, 78.3%; E: 6/9, 66.7%).
CONCLUSION: HBV subgenotype A1 and genotype E are prevalent among HIV/HBV coinfected patients in Maputo, often with high HBV DNA levels and evidence of liver injury. Routine HBV screening, simple fibrosis assessment and further research are recommended.
PMID:42082949 | DOI:10.1186/s12879-026-13454-9
