High Prevalence of Hepatitis B Virus Markers in Romanian Adolescents With Human Immunodeficiency Virus Infection

Abstract

BackgroundWe evaluated the frequency of hepatitis coinfection in Romanian adolescents who were diagnosed with human immunodeficiency virus (HIV) infection prior to 1995.MethodsOne hundred sixty-one adolescents (13–18 years of age) with symptomatic HIV infection, but without signs of hepatic dysfunction, and 356 age-matched, HIV-uninfected controls underwent laboratory testing for markers of parenterally acquired hepatitis virus infection.ResultsSeventy-eight percent of HIV-infected adolescents had markers of past or present hepatitis B virus (HBV) infection, as compared with 32% of controls (P = .0001). The prevalence of HBV replicative markers was more than 5-fold higher in HIV-infected adolescents as compared with controls: 43.4% vs 7.9% (P = .0001), respectively, for hepatitis B surface antigen (HBsAg); and 11.2% vs 2.2% (P = .0001), respectively, for hepatitis B e antigen (HBeAg). The prevalence of HBsAg chronic carriers and the presence of HBV replicative markers was significantly higher in patients with immunologically defined AIDS (CD4+ cell counts < 200 cells/mcL): 59.6% vs 34.6% (P = .02) for HBsAg and 22.8% vs 5.7%, (P = .002) for HBV DNA. After 1 year of follow-up, the proportion of those who cleared the HBeAg was considerably lower in severely immunosuppressed coinfected patients: 4.7% vs 37.1% (P = .003). Four additional HIV-infected adolescents became HBsAg-positive over the term of follow-up (incidence rate, 24.9/1000 person-years), despite a record of immunization against hepatitis B.ConclusionA substantial percentage of HIV-infected and HIV-uninfected Romanian adolescents have evidence of past or present HBV infection. In HIV-infected adolescents, the degree of immunosuppression is correlated with persistence of HBV replicative markers, even in the absence of clinical or biochemical signs of liver disease.

Prevalence of hepatitis B e antigen among human immunodeficiency virus and hepatitis B virus co-infected patients in Jos, Nigeria

“…This finding is similar to other reports from Romania [21] and South Africa [38] that found no relationship between HBV replication markers and HIV viral load among coinfected patients. The reason for the lack of association between HIV viral load and HBV replication markers cannot readily be explained, especially because only a few studies have investigated this relationship.…”

“…The prevalence of HBeAg seropositivity increased with deteriorating immune status reflected by lower CD4+ cell counts. Increasing prevalence of HBeAg with worsening HIVinduced immunosuppression has also been reported by most of the studies that have investigated this relationship in co-infected subjects [21,24,28]. Cellular immunity plays a central role in the pathogenesis of HBV infection.…”

“…A high prevalence of HBeAg in both groups was found; coinfected patients had a significantly higher value than the mono-infected controls. Higher HBeAg prevalence in HIV/HBV co-infected patients than in HBV monoinfected subjects has also been observed in both developed nations and sub-Saharan Africa [4,18,[21][22][23].…”

Characteristics of Hepatitis B Co-infection and Disease Evolution in HIV-Positive Paediatric Patients in Romania

“…The fact that many of these children survived for a long period of time could be related to antiretroviral therapy (ART) and to a prevalent HIV-F subtype (6). According to an epidemiological study of teenagers with HIV in Romania, 78% of HIV patients of this paediatric group had HBV markers of past or present infection and 43.4% had HBV replication markers (7).…”

HIV-1 Subtypes Circulating in Constanta

“…This data comes from the Ministry of Health reporting at the end of May 1991 and is expressed in Figure 2. Children infected between 1986-1990 are a local pediatric cohort, with some common features: first-year infection (either horizontally or vertically by mother-to-child transmission, between 1987 and 1990 [1]), F1 subtype in almost all cases [2], co-infection with hepatitis concomitant with HIV infection [3], almost equal sex distribution [4]. These patients were registered, treated according to national guidelines and benefited from active surveillance of the infection as well as of the associated conditions [5].…”