Health-related quality of life in adults with hepatitis B in sub-Saharan Africa: the added burden of HIV co-infection

Abstract

Chronic hepatitis B (CHB) affects an estimated 82 million people in sub-Saharan Africa (SSA), where HIV co-infection is common and accelerates liver-related complications. While the clinical outcomes of HBV and HIV/HBV co-infection have been well described in SSA, health-related quality of life (HRQoL) remains less well characterized, particularly among individuals at different stages of infection and treatment exposure. We conducted a cross-sectional analysis of baseline data from a longitudinal observational cohort of adults with HBV, with and without HIV, enrolled at five H2Net Consortium sites in Nigeria, Tanzania, and Mali. Participants were categorized into four groups: HBV mono-infection on treatment (HBV-Tx), HBV mono-infection not on treatment (HBV-NTx), HIV/HBV co-infection on treatment (HIV/HBV-Tx), and HIV/HBV co-infection treatment-naïve (HIV/HBV-NTx). HRQoL was assessed using the SF-36 Health Survey and scored according to RAND guidelines. Multivariable linear regression was used to evaluate associations between HRQoL domains and demographic, clinical, and disease-related factors. Among 884 participants (41% HBV-Tx, 33% HBV-NTx, 23% HIV/HBV-Tx, 3% HIV/HBV-NTx), the mean overall HRQoL score was 77.8 (SD 16.9). HRQoL was highest among participants with HBV-NTx [80.56 (SD 14.67)] and lowest among HIV/HBV-NTx[59.38 (SD 23.67)] ( p < 0.01). Across all HRQoL domains, participants with HIV/HBV co-infection reported significantly lower scores compared with those with HBV alone. Energy was the most impaired domain across all groups. In multivariable analyses, HIV/HBV co-infection, both Tx and NTx, was independently associated with lower overall HRQoL and domain specific scores. Elevated fibrosis scores (TE ≥ 7·5kPa/APRI ≥ 1.5), greater comorbidity burden, and older age were also associated with lower overall HRQoL scores and select HRQoL domains. HRQoL impairments, particularly related to energy, emotional wellbeing, and functional limitations, are common among adults with HBV in SSA and are most pronounced in those with HIV/HBV co-infection. These impairments are not fully captured by clinical or virologic markers alone, underscoring the need for integrated care models that address psychosocial and functional health alongside antiviral treatment, particularly among those with HIV/HBV co-infection. Not applicable.