Seroprevalence of hepatitis B and C viral coinfections among children infected with human Immuno-deficiency virus at Kenyatta national Hospital, kenya.

Abstract

Although antiretroviral therapy has reduced the incidence of opportunistic infections among HIV infected individuals in both developed and developing countries, there has been an increase in chronic hepatitis B and C (HBV, HCV) viral infections in developed countries. There is concern that with the increasing access to antiretroviral therapy in resource-poor countries, liver disease due to chronic hepatitis Band C viruses will become important cause of morbidity and mortality. There is little information regarding HCV or HBV co-infection in HIV infected children in Kenya. Thus. not surprisingly the current national guidelines for management of HIV disease in children do not include screening and management of hepatitis viral co-infection. OBJECTIVES To determine the prevalence of Hepatitis B and Hepatitis C co-infections in HIV infected children attending Kenyatta National Hospital and to determine factors associated with HBV/HCV co-infection in HIV infected children including age, history of blood transfusion, sexual activity/abuse, traditional scarification, family history of jaundice, housing crowding index and vaccination status. DESIGN Cross-sectional study SETTING The study was conducted at Kenyatta National Hospital, a 1890 bed referral hospital in Nairobi, Kenya. STUDY SUBJECTS HIV infected children aged 18 months to 17 years. METHODS 2ml of venous blood was drawn from the study subjects and sent to the university of Nairobi Immunology laboratory for HBsAg / Anti HCV screening. 8 RESULTS 195 HIV infected children with a median age of 6.1 years were enrolled in the study. Among them 102 (52.3%) were males and 93 (47.7%) were females. The overall prevalence of hepatitis viral co infection among HIV infected children was about 8.2%. 14 children (7.2%) were co infected with hepatitis Band 2 children (1%) were co infected with hepatitis C. None of the children had dual co infection with both hepatitis viruses. Older children and those who have not been immunized were more likely to have hepatitis B viral co-infection CONCLUSION There is a high sera-prevalence (8.2%) of hepatitis viral co-infection among HIV infected children at KNH. RECOMMENDATIONS 1) Routine screening of HIV infected children for hepatitis B and C viral co-infection. 2) Hepatitis B immunization should be provided to older (more than 8 years) HIV infected children who have not yet been immunized. 3) Current management of pediatric HIV cases needs to address issues related to hepatitis coinfection.