The Prevalence Liver Function and Immunologic Status of Children With Hiv and Hepatitis B Virus Coinfection in Enugu, Nigeria

Abstract

Background: Hepatitis B Virus (HBV) co-infection is prevalent among HIV infected individuals because of shared routes and mechanisms of transmission. The multidimensional immunosuppression from HIV infection causes impaired spontaneous recovery from an acute HBV infection, predisposing to chronic infection which is worsened by younger age at infection. Co-infection increases the risk of HBV replication, hepatotoxicity and liver related deaths from Highly Active Antiretroviral Therapy (HAART). The study was undertaken to highlight the burden of co-infection among HIV positive children in Enugu, determine the associated risk factors and compare the effect of co-infection between co-infected and non-co-infected children using liver enzyme and CD4 counts. Materials and Methods: A cross sectional study was carried out among HIV positive children attending the Paediatric ARV clinic of the University of Nigeria Teaching Hospital, Ituku-Ozalla. A total of 140 HIV infected children aged 18 months to 15 years were recruited. An interviewer questionnaire was administered. Hepatitis B surface antigen (HBsAg) was determined using Determine test Kit. Baseline and recent CD4 counts/CD4% were retrieved from the patients' folders. Results: Fourteen (10%) were positive for HBsAg. The highest prevalence of HBsAg was observed among children aged 11-15 years. The higher the socioeconomic class the less likely the HBsAg positivity. Seven (50%) of the co-infected children had elevated baseline ALT compared with 57 (45.2%) of non-co-infected children though the difference was not statistically significant (t = 0.6, P = 0.56). After the initiation of HAART, 10 (76.9%) of the co-infected and 18 (15.1%) of the non-co-infected children had elevated ALT. The baseline median CD4 count among children ≥ 6 years was 230 cells/mm 3 and 360 cells/mm 3 respectively among the co-infected and nonco-infected, (P = 0.67). However, in children ≤ 5 years, it was 25% and 15 % respectively (P = 0.06). Conclusion: HBV co-infection among HIV infected children is common in our environment, and co-infection is associated with impaired immunity and probably liver enzyme derangement.

Prevalence and burden of HBV co‐infection among people living with HIV: A global systematic review and meta‐analysis

“…The mid-point prevalence was 6.8% (IQR 2.5-10.0). Prevalence ranged from 2% to 20% across six estimates from Nigeria [37][38][39][40][41][42] and between 0% and 20.5% in South Africa. [43][44][45][46] Extremely high prevalence (43%-46%) was observed in Romania in two studies 47,48 where HIV infection was acquired nosocomially prior to 1995.…”

The burden of vaccine-preventable diseases among HIV-infected and HIV-exposed children in sub-Saharan Africa: a systematic review and meta-analysis

“…Fourteen prevalence studies on hepatitis B (HBV) infection in HIV-infected children were pooled together with an estimate prevalence of 5% (95% CI 4 -7, I 2 = 90%). Studies conducted between 2001 and 2010 had a prevalence of 3% (95% CI 2 -5) 67,68 and 4% (95% CI 3 -6) between 2011 and 2018 61,63,64,[65][66][67][68][69][70][71][72]74 (Figure 4).…”

Optimizing decision-making for initiating the treatment of hepatitis b virus infection in resource-limited settings: African consensus guidelines

“…[22][23][24][25] The upper limit of normal (ULN) for ALT for guiding the treatment of chronic HBV infection in African patients may be considered as 35 U/L in males, and 25U/L in females, in line with American guideline recommendations. 23 Derangement of liver enzymes has been noted in both HBV-infected and HBV-HIV co-infected individuals in studies conducted in various African regions; 26,27 elevated levels of aminotransferases have been found to significantly correlate with viral load in HBV-infected individuals. However, the use of liver enzyme levels as a single biomarker for assessing liver damage and/or disease progression is not encouraged.…”