Prevalência de anticorpos contra o vírus da hepatite A em crianças e adolescentes expostos e/ou infectados pelo HIV

Abstract

Objective: To evaluate the prevalence of hepatitis A virus antibodies in HIV-exposed and/or HIV-infected children and adolescents.Methods: Between September 1996 and August 2002, 352 patients (200 exposed, but not HIV-infected and 152 HIV exposed and infected) were included in this study. These children and adolescents (age ranged between 1 and 14 years) were all followed up at the Pediatric AIDS Clinic of the Federal University of São Paulo (UNIFESP) and had anti-HAV antibodies determined by a commercially available ELISA method (tests for total anti-HAV antibodies and specific IgM antibodies) (Dia Sorin and Radim). Statistical analyses were done with chi-squared and t test.Results: The prevalence of hepatitis A virus antibodies in HIV-infected and HIV-exposed, but uninfected patients was 34% and 19.7%, respectively. We noticed that in the age range between 2 years and 10 years, the group of HIVinfected children presented a higher prevalence of hepatitis A virus antibodies (35.5%) than the group of uninfected children (16.7%) (p = 0.005). In the HIV infected group, children from B and C categories had a prevalence of hepatitis A virus antibodies (40.5%) higher than N and A categories (24.1%) (p = 0.042). Mean age did not differ when children from B and C categories were compared with N and A categories (5.18 and 5.66 years, respectively) (p = 0.617). Conclusions:The prevalence of hepatitis A virus antibodies in HIV exposed and/or infected children and adolescents between 1 and 14 years old was 26%. Considering the possibility of HIV infection aggravation when associated with hepatitis A virus infection, we suggest that hepatitis A virus inactivated vaccine should be administered to these patients.

Prevalência de anticorpos contra o vírus da hepatite A em crianças e adolescentes expostos e/ou infectados pelo HIV

“…Until recently, it was claimed that there was no consistent evidence of exacerbated acute liver disease due to HAV in patients with HIV. Gouvêa et al 1 present a succinct review of the literature together with interesting data from their own study which demonstrate the relevance of the association between HIV and HAV. They performed a retrospective analysis of the medical records of 352 patients receiving outpatients treatment at the Pediatric Infectology Department Clinic at the UNIFESP/EPM, in São Paulo.…”

“…There was a greater prevalence of total HAV antibodies in the HIV group for all age groups and no association was observed between immunological category and the presence of HAV antibodies. 1 Despite the decline in HAV incidence over recent years in certain Latin American countries, there are still high rates of disease and even occasional epidemics, indicating that HAV remains an important Public health problem in our country. 2 Studies of pediatric HIV patients response to hepatitis A vaccination are very rare.…”

Vaccination in special situations

“…Pesquisa realizada na UNIFESP com crianças e adolescentes expostos ao HIV revelou que a prevalência de indivíduos suscetíveis à hepatite A entre adolescentes é maior do que na população de não infectados 48 e que a vacina é segura e eficaz, protegendo 100% das crianças infectadas (sem imunossupressão grave) vacinadas 49 . Considerando-se que as crianças com AIDS recebem terapia antiretroviral que é potencialmente hepatotóxica e que a infecção pelo vírus da Hepatite A poderia agravar a infecção pelo HIV, a profilaxia vacinal é importante para esse grupo de pacientes.…”

Vacinação em situações especiais

“…31,40 In Brazil, the hepatitis A vaccine is not available to all HIV-infected children; it must be applied to susceptible individuals who present with hepatopathy in a two-dose schedule with an interval of 6 months between them. 40 Research conducted at UNIFESP with children and adolescents exposed to HIV revealed that the prevalence of individuals susceptible to hepatitis A among adolescents is greater than in the non-infected population 48 and that the vaccine is safe and efficient, protecting 100% of the vaccinated HIV-infected children (without severe immunosuppression). 49 Considering that children with Here we shall deal with the infectious diseases for which the use of vaccines may prevent infection and the disease, even after exposure.…”