The prevalence of hepatitis A antibodies in HIV exposed and/or infected children and adolescents

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 HIVinfected 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 HIV-infected 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. ResumoObjetivo: Avaliar a prevalência de anticorpos contra o vírus da hepatite A em crianças e adolescentes expostos e/ou infectados pelo HIV.Métodos: Entre setembro de 1996 e agosto de 2002, foram incluídos neste estudo 352 crianças e adolescentes, filhos de mães soropositivas para o HIV (200 expostos e não-infectados pelo HIV, e 152 expostos e infectados pelo HIV). Essas crianças e adolescentes, com idade entre 1 e 14 anos, acompanhados no Ambulatório de AIDS Pediátrica da Universidade Federal de São Paulo (UNIFESP), fizeram teste sorológico contra hepatite A como parte da avaliação de rotina. A dosagem de anticorpos anti-HAV (anticorpos totais e IgM) foi realizada através do método ELISA (Dia Sorin e Radim). A comparação das faixas etárias entre os grupos foi feita utilizando o teste do qui-quadrado e, para comparar as médias de idade das categorias clínicas entre as crianças infectadas, utilizou-se o teste t.Resultados: A prevalência de anticorpos contra o vírus da hepatite A foi de 34% nos pacientes infectados e expostos ao HIV e 19,7% no grupo de soro-revertidos (expostos ao HIV e não-infectados). Estratificando a amostra por faixa etária, observamos que, para as crianças de 2 a 10 anos, o grupo de infectados pelo HIV apresentou prevalência de anticorpos para o vírus hepatite A (35,5%) maior do que o gr...

Changes in Hepatitis a Virus Seroepidemiology in Hiv-Infected Brazilian Patients

“…This situation is characteristic of developing countries where the improvement in the hygienic-sanitary conditions contributes to decline the total anti-HAV antibody prevalence rates. 20,22 Statistical significance was observed among age groups from 1994 to 2004, children/youths being more susceptible to HAV than older persons. A low prevalence rate of total anti-HAV antibodies was also observed among children infected with HIV from a Paediatric AIDS Clinic in São Paulo, Brazil.…”

“…A low prevalence rate of total anti-HAV antibodies was also observed among children infected with HIV from a Paediatric AIDS Clinic in São Paulo, Brazil. 22 The advent of HAART in the mid-1990 has allowed HIV-infected individuals to live longer with the disease than in the pre-HAART era. In 2004, 68.5% of HIV-infected patients were under HAART and five individuals older than 70 were observed in the group studied.…”

Persistência de anticorpos contra o vírus da hepatite A após imunização primária e resposta à revacinação em crianças e adolescentes com exposição perinatal ao HIV

“…A previous study on seroprevalence carried out at the Service identified children and adolescents who were seronegative for hepatitis A, 8 who received two doses of the hepatitis A vaccine (Havrix; Glaxo SmithKline Beecham, Rixensart, Belgium) between 2002 and 2003, with a six months interval between doses. 7 At the time of primary immunization, 7 only those infected with HIV through vertical transmission were included; and the following were excluded from the study: patients who had serological evidence of previous infection with hepatitis viruses A, B or C, the ones who had received immunoglobulin in the previous six months, those who were using immunosuppressive drugs, or HIV-infected children who belonged to the clinical category C and immunological category 3.…”

“…Um estudo prévio de soroprevalência no serviço identificou crianças e adolescentes soronegativos para a hepatite A 8 que receberam entre 2002 e 2003 duas doses da vacina hepatite A (Havrix; Glaxo SmithKline Beecham, Rixensart, Bélgica), com intervalo de seis meses. 7 Na época da imunização primária, 7 foram incluídos apenas os infectados pelo HIV por transmissão vertical e excluídos da pesquisa os pacientes que apresentavam evidência sorológica de infecção prévia pelos vírus da hepatite A, B ou C, os que haviam recebido imunoglobulina nos últimos seis meses, aqueles que estavam em uso de imunossupressor ou as crianças infectadas pelo HIV que pertenciam à categoria clínica C e à categoria imunológica 3.…”

Digestive, Hepatic, and Nutritional Manifestations in Latin American Children With HIV/AIDS

“…In 184 clinical charts of HIV‐infected Mexican children from 4 months to 15 years old at the Federico Gomez Children Hospital in Mexico, 466 had undergone radiological studies; in 227 tomographies, the most frequent diagnosis was hepatosplenomegaly (28). The prevalence of hepatitis A in Brazil in 152 HIV‐infected and exposed children was 34%; in 200 noninfected children it was 19.7%; the highest prevalence was in the groups 2 to 10 years old versus noninfected children ( P = 0.05); and in the HIV‐infected group the B and C classes had a higher prevalence than did the N and A classes ( P = 0.042) (29). Hepatotoxicity is a significant problem in patients in highly active antiretroviral therapy; in approximately 6% to 30% of treated patients, antiretroviral therapy is significantly associated with increased liver enzyme serum levels that may require interruption of treatment.…”