title: Seroprevalence of Hepatitis B and C Viruses Among Children in Kilimanjaro Region, Tanzania.
abstract: BACKGROUND
  Data on human immunodeficiency virus (HIV) and hepatitis B virus (HBV) and hepatitis C virus (HCV) coinfection among children in Africa are limited. We evaluated the seroprevalence of both viruses among healthy, HIV-uninfected children and HIV-infected children in the Kilimanjaro region of northern Tanzania.
  
  
  METHODS
  HBV and HCV markers were assessed using serum and plasma samples from HIV-negative children ages 1 month to 18 years, recruited primarily from 2 hospital vaccination clinics; and HIV-infected children 1-16 years of age, enrolled in care and on highly active antiretroviral therapy (HAART). HBV markers included hepatitis B surface antigen (HBsAg), hepatitis B surface antibody, and hepatitis B core antibody (HBcAb). Evidence of any prior HBV infection was defined as a single positive HBsAg or HBcAb result; presumed chronic hepatitis B infection was defined as a single positive HBsAg result. HCV infection was assessed by anti-HCV enzyme-linked immunosorbent assay.
  
  
  RESULTS
  Samples from 547 children were tested. Of 157 children infected with HIV, 9.6% (95% CI: 4.9, 14.2) showed evidence of any HBV infection, compared to 2.1% (95% CI: .6, 3.5) of HIV-negative children. Children with HIV were much more likely to show evidence of HBV infection than children without HIV (odds ratio [OR] = 5.0, P < .0001). Prevalence of presumed chronic HBV infection was 2.9% (95% CI: 1.5, 4.3) overall. Again, prevalence was higher among HIV-infected children (7.0% [95% CI: 3.0, 11.0]) compared to HIV-negative children (1.3% [95% CI: .2, 2.4]; OR = 5.8 [P = .0003]). Of 546 samples tested for anti-HCV antibody, none were positive.
  
  
  CONCLUSIONS
  HBV seroprevalence is high among children in the Kilimanjaro Region, with a significantly higher prevalence among children who are infected with HIV. Routine screening for HBV is needed among HIV-infected children. Patients with coinfection require closer monitoring of liver transaminases due to potential for hepatic toxicities, and they may need HAART regimens that will target both viruses. Guidelines for the management of coinfected children are urgently needed.
authors.affiliation: Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
authors.forename: Florida J
authors.initials: FJ
authors.lastname: Muro
authors.affiliation: Division of Infectious Diseases, University of Colorado, Denver School of Medicine, Aurora.
authors.forename: Suzanne P
authors.initials: SP
authors.lastname: Fiorillo
authors.affiliation: Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
authors.forename: Philoteus
authors.initials: P
authors.lastname: Sakasaka
authors.affiliation: Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
authors.forename: Christopher
authors.initials: C
authors.lastname: Odhiambo
authors.affiliation: Kilimanjaro Christian Medical Centre, Moshi, Tanzania Divison of Infectious Diseases, Department of Medicine, Duke University Medical Center Duke Global Health Institute, Duke University.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Reddy
authors.affiliation: Division of Infectious Diseases, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina.
authors.forename: Coleen K
authors.initials: CK
authors.lastname: Cunningham
authors.affiliation: Kilimanjaro Christian Medical Centre, Moshi, Tanzania Duke Global Health Institute, Duke University Division of Infectious Diseases, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina ann.buchanan@duke.edu.
authors.forename: Ann M
authors.initials: AM
authors.lastname: Buchanan
keywords: Children; HIV; Hepatitis B; Hepatitis C; Sub-Saharan Africa