RESUMO
La administración conjunta de gammaglobulina antihepatitis B y la vacuna se recomienda mundialmente para prevenir la transmisión perinatal en hijos de madres HBsAg(+). Se evaluó la inmunización pasiva-activa a los tres días, 7 y 18 meses de vida, como forma preventiva de esta transmisión. Se estudiaron 87 sueros de hijos de madres HBsAg(+), tomados a los 3 días, 7 y 18 meses de nacidos, para un total de 261 muestras. A los recién nacidos se les administró una dosis de inmunoglobulina humana antihepatitis B cubana (Ganmahep B) y de vacuna recombinante cubana Heberbiovac-HB ® antes de las 12 horas de nacidos y posteriormente a los 1, 2 y 12 meses, según el esquema de vacunación Los niños fueron evaluados con los marcadores HBsAg y anti-HBs. Al tercer día el 8,0 por ciento de los niños fueron HBsAg(+), el 92,5 por ciento de los niños HBsAg(-) resultaron seroprotegidos. A los 7 meses de edad el 1,1 por cientofue HBsAg(+), la seroprotección de los niños HBsAg(-) fue de 89,5 por ciento. El 3,4 por ciento fue HBsAg(+) a los 18 meses, con un 97,6 por ciento de seroprotección en los niños HBsAg(-). Predominó la respuesta normoprotectora en los tres tiempos, con diferencias estadísticamente significativas en la seroprotección y títulos ³ 100 UI/L. Los títulos promedios geométricos (TPG) fueron 72,9 UI/L, 168,66 UI/L y 175,62 UI/L, respectivamente, con significación estadística entre ellos. Se sugiere que el uso de Ganmahep B, conjuntamente con la vacuna cubana reduce el riesgo de transmisión perinatal del VHB y es el primer estudio realizado en Cuba para evaluar la eficacia profiláctica en este grupo de riesgo(AU)
The joint administration of the anti-hepatitis B gammaglobulin and the vaccine is worldwide recommended for the prevention of perinatal transmission to children from HBsAg(+) mothers. As a preventive measure of transmission, passive-active immunization was evaluated after 3 days and at 7 and 18 months of life. Eighty-seven sera from children from HBsAg(+) mothers were studied; these sera were collected 3 days, and 7 and 18 months after birth, for a total amount of 261 samples. Newborns were administered a dose of Cuban Human Anti-hepatitis B Immunoglobulin (Ganmahep B) and a dose of the Cuban recombinant vaccine Heberbiovac-HB® before the first 12 hours after birth. Afterwards, the vaccination scheme at months 1, 2, and 12 was followed. Children were evaluated with HBsAg and anti-HBs markers. At the third day, 8.0 percent of the children were HBsAg(+); the 92.5 percent of HBsAg(-) children turned out to be seroprotected. At 7 months of age, 1.1 percent was HBsAg(+), seroprotection of HBsAg(-) children was 89.5percent. At 18 months of age, 3.4percent was HBsAg(+), with a 97.6percent of protection of HBsAg(-) children. The normoprotective response was predominant at the three periods of time, with statistically significant differences in seroprotection and titers =100 UI/L. Geometric Mean Titer (GMT) values were 72.9 UI/L, 168.66 UI/L and 175.62 UI/L, respectively, with statistical significance among them. It is suggested that the use of Ganmahep B, along with the administration of the Cuban vaccine reduces the risk of HBV perinatal transmission and this is the first study carried out in Cuba to evaluate the prophylactic efficacy within this risk group(AU)
Assuntos
Humanos , Feminino , Gravidez , Recém-Nascido , Recém-Nascido/imunologia , Hepatite B/prevenção & controle , VacinasRESUMO
INTRODUCTION Co-infections between hepatitis B and HIV viruses are frequent due to their similar epidemiological characteristics. Worldwide, hepatitis B infection is one of the main causes of hepatocellular carcinoma and cirrhosis. In Cuba as elsewhere, prevalences of hepatitis B and hepatitis C viral infections are higher in persons with HIV. These hepatitis viruses act as opportunistic infections in persons with HIV. In other contexts, persons with HIV have been found to be at higher risk for occult hepatitis B, defined as the presence in serum or plasma of hepatitis B virus DNA and antibodies to its core antigen, in the absence of hepatitis B surface antigen. OBJECTIVES Describe occult hepatitis B prevalence in Cuban HIV-positive patients and explore possible associations with their clinical characteristics. METHODS A total of 325 serum samples from patients positive for HIV and negative for hepatitis B surface antigen were studied, divided into two groups, Group 1, negative for hepatitis C virus; and Group 2, positive for hepatitis C virus. Exposure to hepatitis B was determined by testing for hepatitis B core antigen; samples positive for hepatitis B core antigen were then examined for presence of antibodies to hepatitis B surface antigen. Both determinations were done by ultramicroELISA. In samples positive for hepatitis B core antigen with levels of antibodies to hepatitis B surface antigen of <50 IU/L, real-time polymerase chain reaction was used to detect hepatitis B DNA and its presence examined in relation to several clinical variables. All data were obtained from patients' clinical records. RESULTS In the hepatitis-C-negative group, 27.9% (68/243) of serum samples tested were positive for hepatitis B core antigen. In the hepatitis-C-positive group, 37.8% (31/82) were positive for hepatitis B core antigen. Total hepatitis B virus exposure prevalence was 30.4% (99/325); 54.5% (54/99) showing low immunity (hepatitis B virus surface antigen <50 IU/L) and 24% of these (13/54), occult hepatitis. There was no statistically significant association between hepatitis B virus DNA and any of the clinical variables studied. CONCLUSIONS Low-immunity HIV-positive persons in our study were exposed to hepatitis B virus. Diagnosis of occult hepatitis B infection is frequent in these patients. This study suggests that diagnostic protocols for persons with HIV and without hepatitis B surface antigen should include testing for hepatitis B core antigen, with positive results followed by molecular techniques to detect occult hepatitis B. This study makes a useful contribution to prevention and control of hepatitis B in Cuba.
