ABSTRACT
Aim: To determine the association between the age at initiation of anti-retroviral therapy (ART) and the 18 month antibody status of human immunodeficiency virus (HIV)-infected children in Jos, Nigeria. Study Design: This was a retrospective cohort study. Place and Duration of Study: AIDS Prevention Initiative in Nigeria (APIN)-supported HIV clinic at Jos University Teaching Hospital, Jos, Nigeria between July 2008 and June 2012. Methods: We reviewed the clinical records of all children confirmed to be HIV-infected with 2 positive HIV deoxyribonucleic acid polymerase chain reaction (DNA PCR) results who were initiated on ART before 12 months of age. We studied the association between the age at initiation of ART and their antibody status at 18months of age. We also studied the association between the viral load and the antibody status. Result: Seventy-three HIV-infected children were initiated on ART at <12 months of age, 66 of these had antibody tests at 18-21 months of age. Nineteen (29%) of the 66 children were negative for rapid antibody test. Those that were initiated on ART at <6 months of age had 5 times the odds ratio of being rapid antibody test negative compared to those who were initiated at ≥6 months of age (AOR=5.23 (1.82-19.66), P=0.002). All the children with negative rapid antibody tests were virally suppressed while all those with detectable viral load were positive for rapid antibody tests. Conclusion: Antibody tests alone cannot be used to determine whether ART should be stopped in children where a definitive diagnosis does not exist. Improved access to affordable, technically simple DNA PCR testing is essential for the appropriate management of HIV-exposed infants in resource limited settings.
ABSTRACT
Aims: To determine the prevalence of HBV co-infection in HIV-infected children and compare the baseline laboratory profile of mono-infected and co-infected patients. Study Design: This was a retrospective cohort study. Place and Duration of Study: AIDS Prevention Initiative in Nigeria (APIN)-supported HIV clinic of Jos University Teaching Hospital, Jos, Nigeria between January 2008 and December 2012. Methodology: We reviewed the clinical records of 452 treatment-naïve children aged 2 months to 15 years confirmed to be HIV positive with Polymerase Chain Reaction (PCR) for children <18 months or Western blot for children ≥18 months. The baseline laboratory tests included: HBsAg, plasma viral load and alanine transaminase (ALT), CD4+T cell count for children ≥5years or CD4+T cell % for children <5years. Results: Three hundred and ninety-four (87.2%) were mono-infected with HIV while 58 (12.8%) were co-infected with HIV and HBV (HIV/HBV). At baseline, the median viral load was 4.6 log copies/mL for mono-infected compared to 4.7 log copies/mL for HIV/HBV (P=.48). The median CD4+T cell count was 366 cells/µL for mono-infected compared to 332 cells/µL for HIV/HBV (P=.64). The median CD4+T cell % was 19% for mono-infected compared to 17% for HIV/HBV (P =.29). The median ALT level for the whole cohort was 23 IU/L for mono-infected compared to 26 IU/L for HIV/HBV (P=.15). However the median ALT level for mono-infected children aged 11-15 years was 28IU/L compared to 43 IU/L for co-infected children of same age (P =.008). Conclusion: A high rate of hepatitis B co-infection was observed in HIV-infected children at our centre; however more severe HIV disease was not observed. Older children co-infected with HBV had significantly higher ALT levels compared to their mono-infected counterparts. Early detection is therefore necessary in order to develop an appropriate treatment plan for children co-infected with HIV and HBV.