HIV and malaria have similar risk factors, and HIV/HBV/HCV co-infection speeds up the development of AIDS, which results in millions of deaths annually throughout the world (Ebong et al., 2022). The study shows interactions between HBV, HCV, and malaria Plasmodium falciparum infections among HIV-infected people in Yenagoa, Bayelsa State, Nigeria, with some developing co-infections. As far as we know, no studies have been conducted in Yenagoa or the South-South region that considered these four illnesses simultaneously. Unfortunately, epidemiological information on HIV/HBV, HIV/HCV, and HIV/HBV/HCV co-infections among HIV patients is scarce and inconsistent domestically and internationally (Shrestha et al., 2022).
The study presents the fundamental demographic and clinical traits of co-infections with HBV, HCV, and malaria (Plasmodium falciparum) in HIV-infected patients. This study's total prevalence of co-infection with HIV and HBV/HCV/malaria (Plasmodium falciparum) was 1.0%. HIV mono-infection was 92.3% among them, while the co-infection rates for HIV/HBV/malaria, HIV/HCV/malaria, and HIV/HBV/HCV were 2.9%, 1.9% and 1.9%, respectively. The results of our study agreed with those of other research from Nigeria and elsewhere.
The 1.0% HBV/HCV/malaria Plasmodium falciparum prevalence reported in this study is comparable to the 1.9% HIV/HBV/HCV and malaria co-infection reported by Mohammed et al. (2016) in Gedarif, Eastern Sudan. In our analysis, triple infections with HIV, HBV, HCV, and Plasmodium falciparum only occurred in those aged 21 to 40 (2.0%), women (1.3%), singles (2.3%), those with university education (2.4%), and students (4.3%). As revealed by Mohammed et al. (2016) in Gedarif, Eastern Sudan, none of these sociodemographic factors was substantially linked (p > 0.05) with triple infections.
The 2.9% reported for triple infections with HIV, HBV, and Plasmodium falciparum in this study is higher than in previous studies. Kogi State had a 0.5% HBV/Plasmodium falciparum co-infection, according to Omatola & Okolo (2021). 1.0% co-infection between malaria and HBV was observed by Adeleke et al. (2013a, b), and 2.2% was reported by Afolabi and Bakare (2022). However, the 5.0% Okonko et al. (2021) recorded in a previous study in Port Harcourt is lower than it.
This study's 2.9% reported rate of triple infections with HIV, HBV, and Plasmodium falciparum is greater than the 0.0% reported by Okonko et al. (2023) in Port Harcourt, Nigeria. It also did not match the conclusions of other earlier investigations. According to Helegbe et al. (2018), Ghana has a 0.7% prevalence of triple infections with HIV, HBV, and Plasmodium falciparum malaria. The prevalence rates of 3.3%, 4.3% and 6.0% were previously reported in various places in Nigeria (Abah et al., 2019; Abah, 2019) and the Gambia (Kotepui & Kotepui, 2020), respectively, they were higher than the figure recorded in the current study. That varies from Anabire et al.'s (2019a, b) results, who reported that 1.9% of patients had P. falciparum/HBV co-infection and similarly recorded opposing values in their study.
In terms of sociodemographic factors linked to HIV/HBV/Malaria Plasmodium falciparum triple infections, males (3.5%), married individuals (3.6%), those with university education (4.8%), and students (8.7%) all experienced greater rates. As revealed by Mohammed et al. (2016) in Gedarif, Eastern Sudan, none of these sociodemographic factors was substantially linked (p > 0.05) with triple infections.
Of these triple infections, HIV/HBV/HCV was 1.9%. This value is less than the 16.9% recorded for triple infection with HBV, HCV, and HIV in Abeokuta, Ogun State, Nigeria (Ogwu-Richard et al., 2015). Several seroprevalences of HIV/HBV/HCV infections were reported in Nigeria in earlier research. According to Forbi et al. (2005), 7.2% of people worldwide have HIV, HBV, or HCV. In Central Nigeria, Balogun et al. (2012) reported a seroprevalence of 3.9% for HIV/HBV/HCV, Okeke et al. (2012) recorded a seroprevalence of 6.5%, and Oti et al. (2021) reported a seroprevalence of 2.8%.
In the same study area, Aaron et al. (2021) and Cookey et al. (2021) reported values of 0.0% and 0.0%, respectively (Port Harcourt, Nigeria). Moreover, the 1.9% reported here exceeds the 1.0% frequency in Central Nigeria that Pennap et al. (2015) reported. It is also greater than the 1.3% and 0.5% found in Edo-Ekiti and Benin, respectively (Ugbebor et al., 2011). (Esan et al., 2014). That is greater than the 0.34% reported for triple infection with HIV, HBV, and HCV by Bhattarai et al. (2018). In contrast to the 1.83% reported by Agarwal et al. (2011), the seroprevalence of 1.9% found here is favourable.
In other places, rates of HIV, HBV, and HCV triple infection of 19.1% and 10.4%, respectively, were observed in China and Myanmar (Zhou et al., 2011). According to Gupta and Singh (2006), North India has a triple infection prevalence of 5.32% and 2.43%, respectively. According to Musyoki et al. (2015), the prevalence of HIV/HBV/HCV infections in South Africa was 29.4%. According to Lonita et al. (2017), 4.4% and 19.0% of Nepal's population are triply infected with HIV, HBV, and HCV. At Kumasi, Ghana, Boateng et al. (2019) found a prevalence of co-infections with HIV, HBV, and HCV of 18.0%. According to Pappoe et al. (2019), Ghana had a 6.1%, 0.5%, and 0.0% prevalence of HIV, HBV, and HCV co-infections, respectively. Similarly, the combined HIV/HBV/HCV prevalence reported by Shrestha et al. (2021) in a systematic review study of Nepal from 1990 to 2020 was 1.3%. In Eastern Nepal, 2.53% of cases of HIV/HBV/HCV triple infections were reported by Shrestha et al. in 2022.
It is essential to note the increased prevalence of HBV and HCV dual infection in this study compared to prior studies (Oti et al., 2021). Furthermore, these studies have shown that triple HIV/HBV/HCV infections or dual HIV/HBV/HCV infections are the most prevalent. However, the incidence of these infections depends on risk categories, the type of exposure involved, and geographic locations (Zhang et al., 2002; Wang et al., 2006; Bao & Liu, 2009; Zhou et al., 2011).
In terms of sociodemographic factors, greater rates of HIV/HBV/HCV triple infections occurred in people over the age of 41 (2.2%), in men (3.5%), in singles (2.3%), in those with university education (4.8%), and in students (4.3%). None of these sociodemographic factors showed a meaningful correlation (p > 0.05). This result contrasts with that of studies by Shrestha et al. (2022), which found that people under 35 were more at risk of co-infection, and Choy et al. (2019), which found that people in their 30s, 40s, and 50s had considerably higher rates of co-infection. The current finding conflicts with that of Oti et al. (2021), who claimed that only educational status was statistically associated with HIV/HCV co-infection in Central Nigeria.
Plasmodium spp. and HCV are known to infect liver cells; hence, given that the hepatitis C and malaria epidemics overlap in some parts of the world, it is conceivable that they might infect and reproduce in the same cell (Asaga et al., 2019). Moreover, it is conceivable that these two illnesses could co-infect, in which case one pathogen could influence the other's severity to rise or fall and vice versa (Asaga et al., 2019). Furthermore, despite substantial research on HCV attachment and entrance due to the virus's rising prevalence worldwide, more research needs to be done on plasmodium entry into host hepatocytes (Asaga et al., 2019). Investigating the co-infection of the three diseases was imperative since it would aid in creating novel treatments and testing equipment. In Yenagoa, Bayelsa State, Nigeria, the study found 1.9% triple infections with HIV, HCV, and Plasmodium falciparum.
In contrast to the 10.9% reported by Asaga et al. (2019) in Abuja, Central Nigeria, this study's 1.9% reported rate of triple infections with HIV, HCV, and Plasmodium falciparum is lower. Sociodemographic indices revealed numerous variations in prevalence across the various groupings. HIV/HCV/malaria Plasmodium falciparum triple infections were more common in people aged 21 to 40 (3.9%), in women (2.7%), in singles (4.7%), in those with tertiary education (4.8%), and in students (8.7%). As revealed by Mohammed et al. (2016) in Gedarif, Eastern Sudan, none of these sociodemographic factors was substantially linked (p > 0.05) with triple infections. This observation disputes the assertion made by Ouwe-Missi-Oukem-Boyer et al. (2011) that age is a significant confounding factor in their setting. Multivariate analysis, on the other hand, suggests that P. falciparum and HCV interact at the hepatic level, with P. falciparum emerging more slowly in HCV chronic carriers. According to Asaga et al. (2019), in HIV-infected people, co-infection rates for malaria and HCV were 8.7% and 11.2%, respectively.
Contrary to a study by Asaga et al. (2019), which found higher rates in the younger age range of 15 to 25 years in Abuja, Nigeria, the higher rates of HIV/HCV/Plasmodium falciparum triple infections were recorded in older age groups > 41 years (2.2%). HCV's tendency could explain the discrepancy in the results to self-limit as a child gets older and eventually acquires the status of a chronic carrier (Asaga et al., 2019). Also, this observation represents a complete departure from a related study in Egypt, where the prevalence ranged from 0.2–5.0% (Galal et al., 2016).
Asaga et al. (2019)'s study, which found higher rates in married women than singles and agrees with our study in that 0.0% prevalence was also reported for participants who had recently divorced, contradicts the higher rates of HIV/HCV/Plasmodium falciparum triple infections reported in singles than other marital groups. The results of Todd et al. (2007), who found that participants with HCV co-infection were less likely to be married, are consistent with our data. In the current study, lifestyle, social activities, and awareness may be the primary deductive reasoning factors contributing to this (Atrah & Ahmed, 1996; Brady & Muir, 2006; Costa et al., 2008; Asaga et al., 2019).
In this study, triple infections with HIV, HCV, and Plasmodium falciparum only occurred in those with tertiary education. Asaga et al. (2019) showed higher rates in women who attended Islamic Quranic schools (20%) compared to postsecondary education level (18.6%). This observation is in contrast to their findings. This finding might be explained by a person's lifestyle, social interactions, and awareness. The results of this study showed complete agreement with the claim made by Oni et al. (2005) that greater levels of education increase the likelihood of sexual adventures, which frequently involve several partners. The results of this investigation showed a complete divergence from those of the Asaga et al. (2019) study. However, it contrasts with the findings of Todd et al. (2007). However, the results of Todd et al. (2007) showed that people with HCV co-infection had a lower likelihood of having a tertiary education.
In addition, our findings indicate that females are more likely than males to have co-infections with HIV/HCV/Plasmodium falciparum and HIV/HBV/HCV/Plasmodium falciparum. The study by Shrestha et al. (2022), which indicated a higher likelihood among males than females, did not support this finding. In contrast, the males were more likely to be coinfected in the study by Lonita et al. (2017). This observation could be a result of female sexual promiscuity. Age and gender of the male were risk variables for co-infection (Gasim & Adam, 2015). It is necessary to determine the precise cause of these differences from other prospective cohort studies.
To the best of our knowledge, there is no information on the relationship between CD4 + T cell count, viral load, and co-infections with HIV, HBV, HCV, and Plasmodium falciparum in Bayelsa State, Nigeria. Only HIV-infected patients with CD4 counts > 500 cells/l (4.0%) and viral loads (VL) 20 copies/ml (2.0%) had a triple infection. Increased HIV/HBV/HCV triple infections were seen in people with CD4 counts between 350 and 499 cells/l (7.1%), viral loads between 20 and 999 copies/ml (2.1%), and TLD ART use (1.9%). Having a CD4 count > 500 cells/l (7.7%), a viral load of < 20 copies/ml (3.8%), and being on Tenofovir, Lamivudine, and Dolutegravir (TLD) ART (2.9%) were also associated with an increased risk of HIV/HBV/MPF triple infections.
Additionally, having a CD4 count > 500 cells/l (4.0%), a viral load of < 20 copies/ml (2.0%), and being on Tenofovir, Lamivudine, and Dolutegravir (TLD) ART (1.9%) were associated with greater HIV/HCV/Malaria Plasmodium falciparum triple infections. In support of Kakisingi et al. (2016), who noted that none of the CD4 count and viral load tested in Lubumbashi, DR Congo, exhibited any statistically significant difference, none of these clinical variables was significantly linked (p > 0.05) with triple infections. Our findings go counter to those of Ebong et al. (2022), who claimed that correlations between the CD4 count and the kind of illness (Plasmodium) or even co-infection (HIV/HCV) had existed. This finding conflicts with research by Bhattarai et al. (2018) and Shrestha et al. (2022), which found co-infection was less common in HIV patients with CD4 cells above 200 cells/mm3. However, a CD4 count under 200 cells/l still carries a substantial risk for opportunistic infections (Browne et al., 2000; Tay et al., 2015). According to George et al. (2015) and Wang et al. (2015), the declining CD4 cell count is a sign of HIV progression and immunological dysfunction, as well as co-infections and various opportunistic infections (Shrestha et al., 2022). Nevertheless, this study's scenario was the opposite. However, research carried out in regions where HIV and malaria are highly endemic discovered a very high viral load and a meagre CD4 count in related individuals (Mermin et al., 2004; Cuadros et al., 2011).
These pathogens' overlap is a significant health concern (Gomez & Hope, 2015; Oti et al., 2021). However, more research is required on the seroprevalence of HBV, HCV, and malaria (Plasmodium falciparum) among HIV-positive patients in Nigeria. When compared to the WHO norm, we discovered that the overlapping infections of HIV/HBV/Plasmodium falciparum, HIV/HCV/Plasmodium falciparum, HIV/HBV/HCV, and HIV/HBV/HCV/Plasmodium falciparum were 2.9%, 1.9%, 1.9%, and 1.0%, respectively (Oti et al., 2021). Chronic HCV carriers' interactions with malaria parasites may prevent the latter from spreading, which may aid in developing novel malaria treatment strategies (Gasim & Adam, 2015). The study also urges establishing a routine HBV, HCV, and Plasmodium screening program employing malaria rapid diagnostic tests (RDT) to identify the preventative actions that must be performed in the treatment of HIV-infected people (Cyrille et al., 2019).