Hepatitis B infection and risk factors among children living with HIV in Yaounde, Cameroon: an integrated management

Abstract

BackgroundThe endemicity of hepatitis B virus (HBV) prompted the systematic immunization of newborns in Cameroon since 2005. In the frame of a considerable burden of HIV/HBV co-infection (17.5%), monitoring HBV among children living with HIV (CLHIV) would guide toward HIV/HBV integrated paediatric care. We sought to ascertain the prevalence and determinants of HBV infection in the population of CLHIV and performance of commonly used rapid diagnosis tests (RDTs).MethodsCross-sectional study conducted from February through June 2017 in a subset of CLHIV ≤15 years old at the Essos Hospital Centre, Yaounde, Cameroon. HBV was tested by HBsAg ELISA sandwich in duplicates for each sample, and the mean optical density was calculated. The Determinants of HBV-prevalencewere evaluated, and p < 0.05 was the significance threshold. The performance of two HBV RDTs (Diaspot vs. HBV-5) was evaluated in comparison to ELISA (used as gold standard).ResultsOf the 83 CLHIV enrolled (54.2% female, mean age 8.7 [±3.8] years, 60% vaccinated against HBV, all breastfed), HBV-prevalence was 2.41% (2/83). HBV-positivity was significantly associated with unknown maternal HBV status (2.9% [2/69] vs. 0.0% [0/14], p = 0.0097) and vaginal delivery (2.4% [2/82] vs. 0.0% [0/1], p = 0.0018). Moreover, the most likely to be positive were aged 11 and 15 years, and had experienced neither anti-HBV vaccination nor anti-HBV serum administration, and both had not been treated with any antiseptic solution at birth. Regarding the performance of Diaspot vs. HBV-5 respectively, sensitivity was 100% (2/2) vs. 50% (1/2), while specificity was 100% (45/45) vs. 97.8% (44/45); positive and negative predictive values of Diaspot versus HBV-5 were respectively 100% (2/2) and 100% (45/45) versus 50% (1/2) and 97.8% (44/45).ConclusionHBV-infection in the population of CLHIV appears at a moderate prevalence, suggesting a decreased burden likely due to preventive measures including the wide vaccine coverage. Focusing on mothers with unknown HBV status and promoting safer delivery mode (caesarean section) for HBV-positive motherswould contribute toward pediatric HBV elimination. In context of limited resources, Diaspot test appears more reliable to rollout HBV-infection in the population of CLHIV. As findings are limited to a small sample size, studies on a wider population would be relevant.

Seroprevalence of hepatitis B and C virus among highly active antiretroviral therapy experienced children in Gondar, Ethiopia

“…The result of this study reveals a higher positivity rates of HBsAg compared to results reported by investigators from West Africa (2.2-5.3%) [20,[35][36][37][38] and comparable positivity rates of anti-HCV (0.5-3.9%) results from the same region [20,37,39].…”

Burden of vaccine-preventable diseases, trends in vaccine coverage and current challenges in the implementation of the expanded program on immunization: A situation analysis of Cameroon

“… 37 While 70% of the global HIV burden is found in SSA, HBV is very prevalent within the Asian (15%) and African populations (8–40%). 38 Even though Cameroon is experiencing declining trends of HBV infections (12% to 11% in 2019) among adults and adolescents aged 15–49 y, 38 the country is still experiencing a generalized epidemic of HBV infections, suggesting the need for evidence-based strategic interventions. This high endemicity seems to be concentrated only in adults (11%), 39 healthcare workers (HCWs) (9%) 40 and pregnant women (8%), 41 as a recent study reported a moderate prevalence of 2% in the pediatric population with similar pattern reported in Ethiopia, Democratic republic of Congo, Tanzania, and Malawi.…”

“…This high endemicity seems to be concentrated only in adults (11%), 39 healthcare workers (HCWs) (9%) 40 and pregnant women (8%), 41 as a recent study reported a moderate prevalence of 2% in the pediatric population with similar pattern reported in Ethiopia, Democratic republic of Congo, Tanzania, and Malawi. 38 This relatively moderate pediatric HBV prevalence could be attributed in part to the wide pediatric coverage of anti-HBV vaccination in Cameroon. Similarly, global reports have stated that universal vaccination has globally decreased HBsAg prevalence in children younger than 5 y from 5% in the pre-vaccination era (1980s to early 2000s) to 1% in 2015.…”

Feasibility and acceptability of integrating hepatitis B care into routine HIV services: a qualitative study among health care providers and patients in West Nile region, Uganda

“…To gain an understanding of feasibility and acceptability from the perspective of patients and care providers, we qualitatively explored views relating to how feasible it is to integrate and how acceptable this integrated HIV/ HBV care model is, as well as the likely influential factors. Although some countries have mentioned the possibility of exploring HBV/HIV care integration, [10][11][12] fewer have actually taken steps to implement integration. This exposes a void in information on the experience and practice of providing integrated care that is holistic for both HIV-and HBV-infected persons.…”