title: Hepatitis B virus prevalence and vaccine response in HIV-infected children and adolescents on combination antiretroviral therapy in Kigali, Rwanda.
abstract: OBJECTIVE
  The aim of this study was to determine the prevalence of hepatitis B virus (HBV) infection in a cohort of HIV-infected Rwandan children and adolescents on combination antiretroviral therapy (cART), and the success rate of HBV vaccination in those children found to be HBV negative.
  
  
  METHODS
  HIV-infected children and adolescents (age 8-17 years) receiving cART with CD4 T-cells count ≥200 cells/mm and/or ≥15% and without prior HBV vaccination (by history, vaccination cards and clinic records) underwent serologic testing for past (negative HBV surface antigen [HBsAg] with positive antibody to HBV core antigen [cAb] and to HBsAg [anti-HBs]) or active HBV infection (positive HBsAg). Children with any positive HBV serologic tests were excluded from further vaccination; all others completed 3 HBV immunizations with 10 µg of ENGERIX-B. Anti-HBs titer was measured 4-6 weeks after the last immunization.
  
  
  RESULTS
  Of 88 children, 6 (7%) children had active HBV infection and 8 (9%) had past HBV infection. The median (interquartile range) age, CD4 T-cell count and cART duration were 12.3 (10.1-13.9) years, 626 (503 to 942) cells/mm and 1.9 (1.5-2.7) years, respectively. Seventeen children had detectable plasma HIV-1 RNA. Seventy-3 children completed 3 immunizations with median (interquartile range) postimmunization anti-HBs concentration of 151 mIU/mL (1.03-650). Overall, 52 children (71%, 95% confidence interval: 61-82) developed a protective anti-HBs response. HIV-1 RNA and CD4 T-cell count were independent predictors of a protective anti-HBs response. Protective anti-HBs response was achieved in 82% of children with undetectable HIV-1 RNA and 77% with CD4 T cells ≥350/mm.
  
  
  CONCLUSIONS
  The substantial HBV prevalence in this cohort suggests that HIV-infected Rwandan children should be screened for HBV before cART initiation. HIV viral suppression and CD4 T cells ≥350/mm favored the likelihood of a protective response after HBV vaccination.
authors.affiliation: Department of Pediatrics, Kigali University Teaching Hospital, Kigali, Rwanda. mutwaph@gmail.com
authors.forename: Philippe R
authors.initials: PR
authors.lastname: Mutwa
authors.forename: Kimberly R
authors.initials: KR
authors.lastname: Boer
authors.forename: John B
authors.initials: JB
authors.lastname: Rusine
authors.forename: Narcisse
authors.initials: N
authors.lastname: Muganga
authors.forename: Diane
authors.initials: D
authors.lastname: Tuyishimire
authors.forename: Peter
authors.initials: P
authors.lastname: Reiss
authors.forename: Joep Ma
authors.initials: JM
authors.lastname: Lange
authors.forename: Sibyl P M
authors.initials: SP
authors.lastname: Geelen
mesh_terms: D000293:Adolescent; D044966:Anti-Retroviral Agents / Q000008:administration & dosage*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D002648:Child; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006510:Hepatitis B Antibodies / Q000097:blood; D006514:Hepatitis B Surface Antigens / Q000097:blood; D017325:Hepatitis B Vaccines / Q000008:administration & dosage / Q000276:immunology*; D019694:Hepatitis B, Chronic / Q000453:epidemiology* / Q000517:prevention & control*; D006801:Humans; D008297:Male; D015995:Prevalence; D011446:Prospective Studies; D012432:Rwanda / Q000453:epidemiology
chemical_list: D044966:Anti-Retroviral Agents; D006510:Hepatitis B Antibodies; D006514:Hepatitis B Surface Antigens; D017325:Hepatitis B Vaccines