Evaluation of selenium as adjunct to HAART in the management of HBV/HIV co-infection in Lagos, Nigeria

Hepatitis B and HIV infections are endemic in the same world regions and share routes of transmission. Co-infection with both viruses is common, with most co-infected individuals living in sub-Saharan Africa and in the Far East. Liver disease due to chronic hepatitis B infection is a leading cause of mortality and morbidity in HIV-positive persons globally. Unlike HIV, HBV virus can survive for days in dried blood and 100 times more transmissible than HIV. Management of viral hepatitis in patients with HIV disease is quite challenging; pharmacologic therapy for co-infected patients is complex; hence, the best strategy for management of HBV/HIV co-infection is not yet defined. This study assessed the HBV/HIV co-infection response to HAART plus selenium. One hundred and forty-nine (149) adult HBV/HIV patients enrolled for the study were followed up for 18 months. Questionnaire for collection of demography was administered to each participant. They were placed either on HAART (Truvada and nevirapine) only or HAART and selenium for those who were eligible for ART. ART-ineligible ones were disqualified for this study. The diagnosis of chronic hepatitis B was based on HBV DNA-positive results, or elevated ALT level. HIV viral load, HBV DNA, CD4 cell count and ALT were analysed at baseline and at the end of the study. Age and sex distributions of HBV/HIV population showed female (59.9%) preponderance. The preponderant age groups were 26-35 (41.5%) and 36-45 (36.1%). Twenty-one (21) participants were lost to follow up. Seven confirmed dead within the study period were HBV/HIV/TB co-infected. Only 121 who completed the study had repeated HBV DNA analysis at 18th month. There was a significant decrease in HBV viral load of all patients who were on HAART at 18th month when compared with baseline data (p=0.0001). The rate of HBV clearance was higher among those on HAART plus selenium, compared to HAART-only group (p=0.046). Efficacy of selenium as an adjunct therapy was 99%. CD4 cell count increment was higher among HAART plus selenium group compared to HAART-only group (p=0.133). Apart from enhancing CD4 cell count, selenium seems to have a protective effect on the liver cells, hence a resultant normalization of the liver enzymes. It is therefore concluded that selenium has a beneficial effect as adjunct to HAART in management of HIV/HBV co-infection and may help to reduce liver cancer.