Forward stepwise logistic regression approach for determinants of hepatitis B & C among Hiv/Aids patients

Document Type : Research Paper


1 Department of Information System, Dr Hasan Murad School of Management, University of Management and Technology, Lahore, Pakistan

2 Faculty of Computer Science and Mathematics, University of Kufa, Iraq

3 Department of Information Technology, ABES Institute of Technology, Ghaziabad, UP, India

4 Department of Computer Science, University of Central Punjab, Lahore, Pakistan

5 Department of Computer Science, College of Computer Science and Information Technology, University of Anbar, Ramadi, Iraq


Hepatitis-related liver diseases are a leading cause of mortality and morbidity among people with HIV/ AIDS taking highly active antiretroviral therapy due to shared transmission routes. An estimated 2–4 million HIV-infected persons have chronic HBV co-infection, and 4–5 million have HCV co-infection worldwide and 14,000 new infections each day. The purpose of this study was to determine the prevalence and associated factors of HBV and HCV co-infection in HIV-positive patients. A cross-sectional study was conducted among 235 HIV/ AIDS patients seeking medical care at special clinics of two public hospitals in Lahore, Pakistan, from February 2018 to May 2018. A structured questionnaire was used to collect information on socio-demographic and clinical characteristics of HIV/ AIDS patients after obtaining their written informed consent. Chi-square, Fisher's exact, and two independent sample t-tests as appropriate were used to find the association between risk factors and HBV, HCV co-infection with HIV. Further, a forward stepwise logistic regression model was used to evaluate the predictors of HBV and HCV co-infection with HIV. P-value < 0.05 was regarded as significant. Of 235 HIV-positive patients, 9\% were co-infected with HBV, 41 were HCV co-infected, and 6\% had HBV-HCV triple infection. The highest prevalence of HBV (55\%), HCV co-infection (70\%), and HBV-HCV triple infection (85\%) were observed in intravenous drug users followed by heterosexual routes. Male, hypertensive, alcohol consumers, and smokers were statistically significantly associated with HBV co-infection $(P-value < 0.05)$. The factors include being male, never married, having $< 1$ year of HIV diagnosis, having $< 200$ CD4 counts (cell/mm3), presence of physical disability, having been infected through sexual routes, injecting drug user, alcohol consumer, and smoker were statistically significantly associated with HCV co-infection $(P-value < 0.05)$. Whereas the factors; heterosexual transmission, intravenous drug use, alcohol use, smoking, and presence of physical disability were statistically significantly associated with HBV, HCV triple infection $(P < 0.05)$. The adjusted odds ratio obtained by fitted logistic regression model showed that HIV transmission routes (both hetero and homo) and never married had lesser odds of HCV co-infection whereas the person with HIV transmission through intravenous drug use, who smoke and aged more than 30 years, had greater odds of HCV co-infection. Co-infection with hepatitis B and C virus is common among this studied sample of HIV-infected patients. The study's finding reaffirms the need for routine baseline screening for this marker and as there is more chance of co-infection with these hepatitis viruses due to enhanced immunodeficiency by HIV and shared routes of transmission. It highlights the need for timely initiation of HAART. Furthermore, those found to be negative should be immunized with HBV and HCV vaccines to improve.


[1] A. Abdulbaqi, A. Abdulhameed, A. Obaid, A secure ECG signal transmission for heart disease diagnosis, Int. J.
Nonlinear Anal. Appl. 12(2) (2021) 1353–1370.
[2] H. Ahmadi Gharaei, M. Fararouei, A. Mirzazadeh, G. Sharifnia, M. Rohani-Rasaf, D. Bastam, J. Rahimi, M.
kouhestani, S. Rezaian and M. Dianatinasab, The global and regional prevalence of hepatitis C and B co-infections
among prisoners living with HIV: a systematic review and meta-analysis, Infect. Dis. Poverty 10(1) (2021) 1–17.
[3] Z.A. Anteneh, E. Wondaye and E.W. Mengesha, Hepatitis B virus infection and its determinants among HIV
positive pregnant women: Multicenter unmatched case-control study, PLoS One 16(4) (2021) e0251084.
[4] T. Asadi and A.J. Obaid, Object-based image retrieval using enhanced SURF, Asian J. Inf. Tech. 15 (2016)
[5] V. Benhammou, R. Tubiana, S. Matheron, P. Sellier, L. Mandelbrot, J.L. Chenadec, E. Marel,B. Khoshnood and
J. Warszawski, HBV or HCV coinfection in HIV-1-infected pregnant women in France: prevalence and pregnancy
outcomes, J. Acquir. Immune Defic. Syndr. 77(5) (2018) 439–450.
[6] J.J. Bigna, A.M. Kenne, A. Hamroun, M.S. Ndangang, A.J. Foka, D.N. Tounouga, R. Lenain, M.A. Amougou
and J.R. Nansseu, Gender development and hepatitis B and C infections among pregnant women in Africa: A
systematic review and meta-analysis, Infect. Dis. Poverty 8(1) (2019).
[7] R. Boateng, M. Mutocheluh, A. Dompreh, D. Obiri-Yeboah, E. Odame Anto, M. Owusu and P.W. Narkwa,
Sero-prevalence of hepatitis B and C viral co-infections among HIV-1 infected ART-na¨ıve individuals in Kumasi,
Ghana, PLoS One 14(4) (2019).
[8] A. Boyd, L.N.C. Dezanet, R. Kassime, P. Miailhes, C. Lascoux-Combe, J. Chas, P.-M. Girard, J. Gozlan, F.
Zoulim, C. Delaugerre, H. Rougier and K. Lacombe, Subclinical and clinical outcomes in patients co-infected
with HIV and chronic hepatitis B virus from clinical outpatient centers in France: protocol for an ambispective,
longitudinal cohort study, JMIR Res. Protoc. 10(4) (2021).
[9] H.-R. Cheng, C.-J. Liu, T.-C. Tseng, T.-H. Su, H.-I. Yang, C.-J. Chen and J.-H. Kao, Host genetic factors
affecting spontaneous HBsAg seroclearance in chronic hepatitis B patients, PLoS One 8(1) (2013).
[10] S.S. Custer, Management of co-infections in patients with human immunodeficiency virus, Nurs. Clin. North Am.
53(1) (2018) 83–96.
[11] G.U. Eleje, A. Rabiu, I.I. Mbachu, G.O. Akaba, O.M. Loto, H.A. Usman, P.O. Fiebai, R.C. Chukwuanukwu, N.N.
Joe-Ikechebelu, C.H. Nwankwo, S.O. Kalu, C.U. Onubogu, C.N. Ogbuagu, S.N. Chukwurah, C.E. Uzochukwu,
S.O. Inuyomi, B.A. Adesoji, U.C. Ogwaluonye, E.A. Emeka, R.O. Egeonu, O.E. Igue, C.H. Jibuaku, O.D. Okoro,
P.O. Aja, C.P. Chidozie, H.S. Ibrahim, F.E. Aliyu, A.I. Numan, S.A. Omoruyi, I.C. Oppah, U.I. Anyang, A.
Ahmed, O.S. Umeononihu, E.O. Umeh, S.I. Nweje, I.C. Ajuba, C.C. Okoro, A.A. Onwuegbuna, E.P. Igbodike,
I.K. Nwaeju, I.A. Yakasai, O.C.E.O.C. Ezechi and J.I. Ikechebelu, Awareness and prevalence of hepatitis C virusinfection among pregnant women in Nigeria: A national pilot cross-sectional study, Women’s health (London,
England), 17 (2021).
[12] M.A. Erasmus, N.P. Akani, L.O. Amadi and J.O. Williams, The prevalence of hepatitis B and C among HIV
positive patients in some hospitals in rivers state, J. Adv. Microbiol. 21(8) (2021) 1–8.
[13] O. Falade-Nwulia, E.C. Seaberg, A.E. Snider, C.R. Rinaldo, S.M. Wolinsky, M.D. Witt and C.L. Thio, Outcomes
of acute hepatitis B virus (HBV) in HIV infection with and without HBV-active antiretroviral therapy, AIDS
35(6) (2021) 991–993.
[14] B. Gao, L. Wang, A.J. Santella, G. Zhuang, R. Huang, B. Xu, Y. Liu, S. Xiao and S. Wang, HIV testing behaviors
and willingness to receive oral rapid HIV testing among dental patients in Xi’an, China, PLoS One 16(3) (2021).
[15] G. Ionita, A. Malviya, R.Rajbhandari, W.W. Schluter, G. Sharma, S. Kakchapati, S. Rijal and S. Dixit, Seroprevalence of hepatitis B virus and hepatitis C virus co-infection among people living with HIV/AIDS visiting
antiretroviral therapy centres in Nepal: a first nationally representative study, Int. J. Infect. Dis. 60 (2017) 64–69.
[16] T. Kamenya, D.J. Dami, J.S. Ngocho, R.N. Philemon, M.J. Mahande and S.E. Msuya, The prevalence of hepatitis B virus among HIV-positive patients at Kilimanjaro Christian Medical Centre Referral Hospital, Northern
Tanzania, PAMJ. 28(275) (2017).
[17] S. Kautish, S.-L. Peng and A. J. Obaid, Computational Intelligence Techniques for Combating COVID-19,
Springer International Publishing, 2021.
[18] H.N. Kim, Chronic hepatitis B and HIV coinfection: a continuing challenge in the era of antiretroviral therapy,
Curr. Hepatol. Rep. 19(4) (2020) 345–353.
[19] H.-T. Kinkel, D. Karmacharya, J. Shakya, S. Manandhar, S. Panthi, P. Karmacharya, D. Sitaula, R. Thapaliya,
K.C. Prawachan, A. Rai and S. Dixit, Prevalence of HIV, hepatitis B and C infections and an assessment of
HCV-genotypes and two IL28B SNPs among people who inject drugs in three regions of Nepal, PLoS One 10(8)
(2015) e0134455.
[20] T.B. Kwofie, D. Adigbli, J. Osei-Yeboah, E. Ativi and S.Y. Lokpo, Hepatitis B and C infections in HIV-1 patients
on combination antiretroviral therapy (cART) in Ghana: implications for immunologic recovery, clinical response
to treatment, and hepatotoxicity, Heliyon 7(6) (2021).
[21] M.A. Lawal, O.F. Adeniyi, P.E. Akintan, A.O. Salako, O.S. Omotosho and E.O. Temiye, Prevalence of and risk
factors for hepatitis B and C viral co-infections in HIV infected children in Lagos, Nigeria, PLoS One 15(12)
(2020) e0243656.
[22] S. Leumi, J.J. Bigna, M.A. Amougou, A. Ngouo, U.F. Nyaga, J.J. Noubiap, Global burden of hepatitis B infection
in people living with human immunodeficiency virus: a systematic review and meta-analysis, Clin. Infect. Dis.
71(11) (2020) 2799–2806.
[23] E.M. Mbaawuaga, C.U. Iroegbu, A.C. Ike, E.M. Mbaawuaga, C.U. Iroegbu and A.C. Ike, Hepatitis B Virus
(HBV) serological patterns in benue state, Nigeria, Open J. Med. Microbiol. 4(1) (2014) 1–10.
[24] T.A. Mezgebo, S. Niguse, A.G. Kahsay, H. Hailekiros, N. Berhe and T.A. Dejene, Hepatitis B virus infection and
associated risk factors among pregnant women attending antenatal care in health facilities of Tigray, Northern
Ethiopia, J. Med. Virol. 90(3) (2018) 503–509.
[25] B.M. Muriuki, M.M. Gicheru, D. Wachira, A.K. Nyamache and S.A. Khamadi, Prevalence of hepatitis B and C
viral co-infections among HIV-1 infected individuals in Nairobi, Kenya, BMC Res. Notes 6(1) (2013).
[26] L. P´erez-Latorre, J. Berenguer, R. Mic´an, M. Montero, C. Cifuentes, T. Puig, J. Sanz, O.L. Ferrero, B. De
La Fuente, C. Rodr´ıguez, S. Reus, J. Hern´andez-Quero, G. Gaspar, L. P´erez-Mart´ınez, C. Garc´ıa, L. Force, S.
Veloso, M. De Miguel, I. Jarr´ın and J. Gonz´alez-Garc´ıa, HIV/HBV co-infection: temporal trends and patient
characteristics, Spain, 2002 to 2018, Eurosurveillance 26(25) (2021).
[27] M. Puglia, C. Stasi, M. Da Fr`e and F. Voller, Prevalence and characteristics of HIV/HBV and HIV/HCV coinfections in Tuscany, Braz. J. Infect. Dis. 20(4) (2016) 330–334.
[28] C. Stasi, C. Silvestri and F. Voller, Update on hepatitis C epidemiology: unaware and untreated infected population
could be the key to elimination, S.N. Compr. Clin. Med. 2(12) (2020) 2808–2815.
[29] A. Teimoori, S. Ebrahimi, N. Keshtkar, S. Khaghani, S. Salmanzadeh and S. Ghafari, Prevalence and genetic
diversity of HCV among HIV-1 infected individuals living in Ahvaz, Iran, BMC Infect. Dis. 19(1) (2019).
[30] A.C. Thornton, S. Jose, S. Bhagani, D. Chadwick, D. Dunn, R. Gilson, J. Main, M. Nelson, A. Rodger, C. Taylor,
E. Youssef, C. Leen, M. Gompels, S. Kegg, A. Schwenk and C. Sabin, Hepatitis B, hepatitis C, and mortality
among HIV-positive individuals, AIDS 31(18) (2017) 2525–2532.
[31] T. Yang, Q. Chen, D. Li, T. Wang, Y. Gou, B. Wei and C. Tao, High prevalence of syphilis, HBV, and HCV
co-infection, and low rate of effective vaccination against hepatitis B in HIV-infected patients in West China
hospital, J. Med. Virol. 90(1) (2018) 101–108.
[32] C. Zhang, Q. Ren and W. Chang, Epidemiological features and risk factors for acquiring hepatitis B, hepatitis C,and syphilis in HIV-infected patients in Shaanxi Province, Northwest China, Int. J. Environ. Res. Public Health
17(6) (2020).
Volume 12, Special Issue
December 2021
Pages 1367-1396
  • Receive Date: 14 July 2021
  • Revise Date: 01 August 2021
  • Accept Date: 12 September 2021