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/mm3 and 360 cells/mm3 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