Prevalence and Clinical and Immunoviralogical Profile of Human Immunodeficiency Virus-Hepatitis B Coinfection among Children in an Antiretroviral Therapy Programme in Benue State, Nigeria
Background. Nigeria has the world largest burden of paediatric HIV and is also highly endemic for Hepatitis B virus (HBV). However, relatively little is known regarding the prevalence of HBV-HIV coinfections among Nigerian children. Methods. A retrospective study among treatment naive HIV-infected children attending the pediatric clinic of the APIN Plus/Harvard PEPFAR program of the Federal Medical Centre, Makurdi, between June 2008 and June 2012. Results. The mean age of the 395 subjects studied was years. Thirty-one subjects (7.8%) were positive for HBV. No subject was HIV-HBV-HCV triply infected. Significantly higher HIV-HBC coinfections were found, in older subjects (11–15 years), subjects that did not receive nor complete Hepatitis B vaccinations, and subjects that had a severe immunosuppression of < 15% with respective values of 0.00, 0.01, and 0.00. HIV-HBV co-infection did not significantly impact on other baseline characteristics including, gender, WHO clinical stage, median absolute CD4 count, mean viral load, median ALT, and hepatotoxicity. Conclusion. A high seroprevalence of HBV among this cohort of HIV-infected children contributes to the calls for pre-ART screening for HBV and the necessary paradigm shift in the ART nucleoside backbone to include agent(s) more dually effective against HIV and HBV. 1. Introduction With an estimation of 250,000 children infected with HIV, Nigeria accounts for more than 10% of the global paediatric HIV burden [1]. More than 90% of these infections were vertically acquired from mother to child. Nigerian coverage of Prevention of Mother to Child Transmission (PMTCT) strategies has meagerly increased from 5.3% in 2007 to 11% in 2010 [2]. This implies that many new paediatric infections continue to occur, with Nigeria accounting for 30% of the global PMTCT gaps [1]. Regional differences in the HIV burden exist in Nigeria. Benue State, located in the North Central region, had the highest estimated HIV prevalence of 12.7% in 2010 [2–4]. Several other pathogens including Hepatitis B virus are acquired vertically with the attendant risks of coinfections and the complex interactions. Nigeria is also known to be highly endemic for Hepatitis B viral (HBV) infection [5]. There is a relative paucity of data on HIV/HBV coinfection. A few studies have reported rates ranging from prevalence of 7.7%, to 19% of HIV-HBV coinfections in Nigerian children [6–8]. Precariously, the prevalence of pediatric HBV-HIV coinfections may be higher as most HBV infections occur within the first 5 years of life in children in Africa [9]. In
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