Retention in care and viral suppression in people living with HIV and chronic hepatitis B in Maputo City, Mozambique: a prospective cohort study

Abstract

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.