Aim: To investigate the prevalence and genotypic profile of overt and occult hepatitis-B infection (OBI) among
HIV-infected individuals in Cameroon.
Methods: 212 HIV-infected Cameroonians, aged 37.6 [IQR: 32.6-46.6] followed-up at the University Health Centre in
Yaoundé, were tested for HBsAg, anti-HBs, anti-HBc IgG/IgM, HBV-DNA and anti-HCV IgG. HBV positive cases were
tested for Hepatitis Delta virus (HDV) using anti-HDV IgG and HDV-RNA. Liver function was assessed by alanine and
aspartate aminotransaminases. OBI was defined as negative-HBsAg and detectable HBV-DNA. In occult or overt HBVinfected
participants, HBV reverse transcriptase (RT)/surface (S) sequences were analyzed for drug resistance, immuneescape
mutants, and phylogeny.
Results: Overall, 78.3% (166/212) participants had past/ongoing HBV-exposure, with 39.1% (83/212) carrying “HBcAbpositive
alone”. Prevalence of overt HBV (positive-HBsAg) was 11.8% (25/212), prevalence of HBV and HDV was
respectively 6.9% (12/175) and 12% (3/25). Phylogeny of HBV-RT/S revealed the co-circulation of genotypes A and E.
All HBV-coinfected participants harbored HBV strains with at least one immune-escape mutation. Of note, one HBV
variant carried the vaccine-escape mutation G145R that hinders HBsAg neutralization by antibodies. For the first time, a
novel 9 aa-deletion (s115-s123), located in the HBsAg “a” determinant, was found concomitantly with OBI. A stop codon
in the S region (associated with increased risk of hepatocellular carcinoma) was found in six cases.
Conclusion: High prevalence of overt/occult HBV-infection and circulating atypical strains highlight the importance of
HBV-surveillance among HIV-infected Cameroonians and strategies to detect OBI in highly endemic countries.