THE PREVALENCE LIVER FUNCTION AND IMMUNOLOGIC STATUS OF CHILDREN WITH HIV AND HEPATITIS B VIRUS COINFECTION IN ENUGU, NIGERIA.
BACKGROUND
Hepatitis B Virus (HBV) co-infection is prevalent among HIV infected individuals because of shared routes and mechanisms of transmission. The multidimensional immunosuppression from HIV infection causes impaired spontaneous recovery from an acute HBV infection, predisposing to chronic infection which is worsened by younger age at infection. Co-infection increases the risk of HBV replication, hepatotoxicity and liver related deaths from Highly Active Antiretroviral Therapy (HAART). The study was undertaken to highlight the burden of co-infection among HIV positive children in Enugu, determine the associated risk factors and compare the effect of co-infection between co-infected and non-co-infected children using liver enzyme and CD4 counts.


METHODS
A cross sectional study was carried out among HIV positive children attending the Paediatric ARV clinic of the University of Nigeria Teaching Hospital, Ituku-Ozalla. A total of 140 HIV infected children aged 18 months to 15 years were recruited. An interviewer questionnaire was administered. Hepatitis B surface antigen (HBsAg) was determined using Determine test Kit. Baseline and recent CD4 counts/CD4% were retrieved from the patients' folders.


RESULTS
Fourteen (10%) were positive for HBsAg. The highest prevalence of HBsAg was observed among children aged 11- 15 years. The higher the socioeconomic class the less likely the HBsAg positivity. Seven (50%) of the co-infected children had elevated baseline ALT compared with 57 (45.2%) of non-co-infected children though the difference was not statistically significant (t = 0.6, P = 0.56). After the initiation of HAART, 10 (76.9%) of the co-infected and 18 (15.1%) of the non-co-infected children had elevated ALT. The baseline median CD4 count among children ≥ 6 years was 230 cells/mm3and 360 cells/mm3respectively among the co-infected and non- co-infected, (P= 0.67). However, in children ≤ 5 years, it was 25% and 15 % respectively (P= 0.06).


CONCLUSIONS
HBV co-infection among HIV infected children is common in our environment, and co-infection is associated with impaired immunity and probably liver enzyme derangement.
department of Pediatrics, Enugu State University Teaching Hospital, Enugu, Nigeria.
Uleanya Nwachinemere
UN
Davidson
Department of Pediatrics, Federal Teaching Hospital, Abakiliki, Ebonyi State, Nigeria.
Nwokoye Ikenna
NI
Chidiebele
Department of Pediatrics, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State, Nigeria.
Emodi Ifeoma
EI
Josephine
Department of Pediatrics, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State, Nigeria.
Obidike Egbuna
OE
Olakunle
Department of Pediatrics, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State, Nigeria.
Ikefuna Anthony
IA
Nnaemeka
Department of Pediatrics, James Cook University Hospital, Middlesborough, England. nulesa2001@yahoo.com.
Eze Jude
EJ
Chijioke
department of Pediatrics, Enugu State University Teaching Hospital, Enugu, Nigeria.
Ndu Ikenna
NI
Kingsley
Children; HBV co-infection; HIV infection; Immunologic status; Liver function