HIV/ HBV coinfected patients are at high risk of developing chronic HBV infection, liver cirrhosis and hepatocellular carcinoma. In Mozambique, where HIV prevalence is one of the highest in the world, HIV-infected patients are scarcely characterized in terms of HBV coinfection and 3TC-resistance mutations profile. To characterize ART-naïve HIV-infected adults, with and without HBV coinfection, a cross-sectional study was conducted between May and November 2012 in two health centers from Maputo city, Mozambique. Subjects were consecutively enrolled in the study and, then, tested for hepatitis B surface antigen (HBsAg). Moreover, CD4⁺ T cells count, HBV DNA in plasma, HBV genotyping and 3TC-resistance mutations profile of HBV were assessed in HIV/HBV coinfected patients. In total, 518 patients were enrolled in the study. The median age was 33 years old and 66.8% were women. The median CD4⁺ T cells count was 361 cells/mm³ and 47 (9.1%) were coinfected with HBV. Out of 46 coinfected patients, 24 (55.2%) had HBV DNA ≥ 20 - < 20 000 and 12 (26.1%) had HBV-DNA ≥20 000. APRI > 2.0 was reported in 4.3% of coinfected and 1.7% of monoinfected patients (p = 0.228), while FIB-4 > 3.25 was reported in 4.4% of coinfected and 1.3% of monoinfected patients (p = 0.112). Genotype A was the most frequent, identified in 25/27 (92.6%) patients, whereas genotype E was present in 2/27 (7.4%) patients. No patient had 3TC-resistance mutations. This study showed that HBV coinfection was prevalent among ART-naïve HIV-infected adults in Mozambique. Overall, these data highlight the importance of screening HBV coinfection as an integrated measure of HIV routine care to improve health conditions and treatment of HIV/HBV coinfected patients.

Introduction: Globally, more than 254 million people are living with hepatitis B virus (HBV), and 7.4% of the people living with HIV (PLHIV) are coinfected with HBV. More than 70% of them reside in Africa. We aimed to describe the characteristics of newly diagnosed antiretroviral treatment (ART)-naïve HIV/HBV co-infected and HIV monoinfected patients. Methods: This cross-sectional study included newly HIV-diagnosed ART-naïve patients recruited at Mavalane Health Centre located in a periurban area of Maputo City. Between May 2021 and November 2022, all patients over 18 years old were enrolled and screened for hepatitis B surface antigen (HBsAg). Data on socio-demographic and clinical characteristics, haematology, liver and kidney function tests, CD4+T cell counts, serological markers of hepatitis B (IgM Core hepatitis B antibody, hepatitis B e antigen, and hepatitis B e antibody), HIV and HBV viral loads were assessed using standard procedures. Results: A total of 1106 participants were included. The age of the participants ranged from 18 years to 71 years with a median of 34.0 (IQR: 28.0–42.0) years, 513 (46.4%) were men and HBsAg was reactive in 81 participants, yielding a co-infection rate of 7.3%. Being male (OR, 1.72; 95% CI, 1.06 to 2.83) or a sex worker (OR, 3.69; 95% CI, 1.10 to 10.58) was associated with the co-infection. The median Aspartate Aminotransferase-Platelet Ratio Index (APRI) of the HIV/HBV co-infected was 0.5 (IQR 0.3–1.1), with 40/81 (49.4%) presenting with an APRI>0.5. Overall, 67/81 (80.2%) of the co-infected people were HBeAg-negative. The median APRI was 0.5 (IQR, 0.3–1.1) for the HBeAg-negative and 0.7 (IQR 0.3–1.4) for the HBeAg-positive subjects. The median HBV-DNA was 258.0 IU (IQR, 10.0–4974.5) for the HBeAg-negative and 746 287.0 IU (IQR 2720.0–49 899 213.0) for the HBeAg-positive subjects. Two (3.0%) HBeAg-negative and one (7.1%) HBeAg-positive subjects presented with hepatocellular carcinoma. Conclusion: These data confirm the high prevalence of HIV/HBV co-infection in Mozambique and bring new data related to HBeAg status, reinforcing the need to test all PLHIV for HBV and to integrate the management and monitoring of hepatitis B and liver disease-specific tests in public ART programmes to predict and reduce the occurrence of HBV complications and mortality.

Background: Meningitis remains an important cause of morbi-mortality in adults in sub-Saharan Africa. Data on the etiological investigation of meningitis in adults in Mozambique is limited and most studies were conducted in southern Mozambique. Identification of the etiology of meningitis in adults are crucial to guide prevention and treatments strategies. In this study, we determine the burden of fungal and bacterial meningitis among adults at the three largest hospitals in Mozambique. Method: We performed analysis of data from the routine sentinel surveillance system for meningitis in Mozambique from January 2016 to December 2017. Cerebrospinal fluid (CSF) samples were collected from eligible adults (≥18 years old) who met World Health Organization (WHO) case definition criteria for Meningitis. All samples were tested by cryptococcal antigen (CrAg) lateral flow assay (LFA), culture and triplex real-time polymerase chain reaction (qPCR) assay and all patients were tested for human immunodeficiency virus (HIV) using the national algorithm for HIV testing. Results: Retrospective analysis of 1501 CSF samples from adults clinically suspected of meningitis revealed that 10.5% (158/1501) were positive for bacterial and fungal meningitis. Of these 158 confirmed cases, the proportion of Cryptococcal meningitis and pneumococcal meningitis was38.6% (95% CI: 31.0% to 46.7%) and 36.7% (95% CI: 29.2% to 44.7%), respectively. The other bacterial agents of meningitis identified include Neisseria meningitidis (8.9%; 14/158), Escherichia coli (6.3%; 10/158), Haemophilus influenzae (5.1%; 8/158) and S. aureus (4.4%; 7/158), which represent (24.7%; 39/158) of the total confirmed cases. Conclusion: Altogether, our findings show a high burden of Cryptococcal meningitis among adults in Mozambique, especially in people living with HIV, followed by pneumococcal meningitis. Our findings suggest that rollout of CrAg Lateral Flow Assay in the health system in Mozambique for early detection of cryptococcus neoformans is necessary to improve overall patient care.

Hepatitis B virus (HBV) is a major public health concern responsible for hepatitis and hepatocellular carcinoma (HCC) worldwide. In Mozambique, HBsAg prevalence is high and endemic, and despite the strategies to mitigate the spread of the disease, the HCC incidence is still high and one of the highest in the world. There is still limited data on the serological profile and molecular epidemiology of HBV in Mozambique given the burden of this disease. In this study, we aimed to describe the serological and molecular characterization of HBV among blood donors. We conducted a cross-sectional survey from November 2014 to October 2015 at the Blood Bank of the Hospital Central de Maputo. Serological testing and molecular testing were performed. The frequency of HBV infection was estimated at 4.4% and was higher among males (79.1%), individuals aged 25–39 years (55.2%), and replacement donors (89.6%). The median viral load of HBV-positive blood donors was 1288.5 IU/mL, and 43.8% had a viral load higher than 2000 IU/mL. Most of the sequenced samples (94.3%) belonged to subgenotype A1. These findings underscore the importance of ongoing surveillance to inform effective HBV control strategies and present evidence about the burden of HBV among blood donors, which definitely requires attention, and clinical blood banks in Mozambique and in similar settings.

Early antiretroviral treatment (ART) has reduced mortality among people living with HIV (PLHIV), but outcomes for HIV-HBV coinfected people in Sub-Saharan Africa remain poorly understood. This study evaluated the impact of HBV coinfection on 12-month retention in care, attrition, mortality, lost to follow-up (LTFU) and viral suppression among PLHIV. This prospective cohort study enrolled newly diagnosed, ART-naïve PLHIV at Mavalane Health Center, Maputo City, from May 2021 to November 2022 and followed participants for 12 months with multiple visits. Monthly cumulative retention, attrition, mortality, and LTFU were calculated; viral suppression was assessed at 6 and 12 months. Associations between baseline characteristics and time-to-event outcomes (attrition, mortality, and LTFU) were evaluated using Cox proportional hazards models. A total of 1,106 participants were enrolled in the study, of whom 81 (7.3%) were HBsAg-positive. Median age was 34.0 years (IQR: 28.0-42.0), and 593 (54.6%) were female. Among the participants, 17.3% of monoinfected and 22.2% of coinfected had a CD4⁺ T Cell count below 100 cells/mm³. Overall retention was 89.4% (95% CI, 87.4-91.2) at 6 months and 83.8% (95% CI, 81.5-85.9) at 12 months, with lower retention in coinfected individuals [85.2% (95% CI, 75.6-92.1) vs. 89.8% (95% CI, 87.7-91.5) at 6 months; 75.3% (95% CI, 64.5-84.2) vs. 84.5% (95% CI, 82.1-86.7) at 12 months]. Among coinfected participants, females had lower retention than males [6 months: 78.8% (95% CI, 61.1-91.0) vs. 89.6% (95% CI, 77.3-96.5); 12 months: 72.7% (95% CI, 54.5-86.0) vs. 77.1% (95% CI, 62.7-88.0)]. Mortality and LTFU rates were higher in coinfected participants during the first 6 months (mortality: 13.8 vs. 8.4 per 100 person-years; LTFU: 19.3 vs. 13.7 per 100 person-years). Viral suppression at 6 months was similar [coinfected: 83.6% (95% CI, 71.9-91.8) vs. monoinfected: 81.1% (95% CI, 78.2-83.7)], but was lower in coinfected participants at 12 months, [79.6% (95% CI, 66.5-89.4) vs. 87.4% (95% CI, 84.8-89.7)]. These findings underscore ongoing challenges in retention in care, mortality, and viral suppression among HBV coinfected PLHIV, supporting routine HBV screening, integrated HIV-HBV care, and targeted retention interventions.

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. 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). 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%). 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.