Emmanuel Seremba, MBChB

Nominated From: University of Washington

Research Site: Uganda

Research Area: HIV and Liver Diseases

Primary Mentor: Corey Casper

Research Project

Strategies for the Prevention of Hepatitis B Viral Infection Among HIV-Infected Ugandans

With the introduction of highly active antiretroviral therapy (HAART) in developed countries, death from AIDS-related causes has declined but liver diseases have become one of the leading causes of morbidity and mortality among HIV-infected patients. The majority (over 80%) of these liver related deaths are attributed to viral hepatitis B and C and adverse effects of HAART. In Uganda, hepatitis B (HBV) is second to medications in causing liver disease among HIV patients, and HIV-positive persons are at higher risk of end-stage liver disease and hepatocellular carcinoma (HCC). Uganda is highly endemic for HBV and HIV with prevalence rates of 10% and 6.4% respectively. The HBV prevalence among HIV-infected Ugandans ranges from 4-18%, but little is known about the incidence of HBV among HIV-positive Ugandan adults. Recent work in Uganda shows that the prevalence of HBV continues to increase with age among HIV-infected adults suggesting that many liver-related complications of HIV/HBV co-infection could be prevented by HBV vaccination. Currently, the national policy in Uganda and some other African countries limits HBV vaccination to infants. We propose to study both the incidence of HBV in HIV-positive individuals, as well as two different approaches to achieving immunity to HBV among HIV-positive Ugandan adults.

Research Significance

Results from this study are anticipated to inform clinical practice guidelines as well as health care policy in Uganda and sub-Saharan Africa whether HIV‐infected individuals in the region are at a high risk for HBV acquisition, and to guide the choice of an appropriate strategy for HBV vaccination for this subpopulation.

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