PREVALENCE OF HEPATITIS C ANTIBODY IN HUMAN IMMUNODEFICIENCY VIRUS INFECTED CHILDREN AGED 2 – 15 YEARS AT AHMADU BELLO UNIVERSITY TEACHING HOSPITAL ZARIA

Abstract

Hepatitis C virus (HCV) is increasingly becoming a major public health problem for the
Human Immunodeficiency virus (HIV) infected population. Both infections share the same
routes of transmission, and quite often co-exist, with dual infections associated with
reciprocal and mutually more rapid progression than either infection alone. Furthermore, co
infection impacts on the course and management of both infections, especially an increased
risk of ARV-induced hepatotoxicity. This study was carried out to document the prevalence,
risk factors and other determinants of HCV antibody in HIV-infected children aged two to
fifteen years in ABUTH Zaria.
A total of 132 HIV-infected children attending the Paediatric Antiretroviral Clinic of
ABUTH Zaria who satisfied the inclusion criteria were recruited as study subjects. Another
132 HIV negative children attending other clinics, matched for age and sex, were recruited as
controls. The study was conducted between November 2008 and August 2010. Blood sample
was obtained from each child recruited for the study and from their mothers where available,
and assayed for the presence of HCV antibody using a membrane-based, one step test
immune-assay kit.
Thirteen of the subjects had a positive HCV antibody giving the prevalence of HCV
antibody in HIV-infected children of 9.8%. In the control group, 4 children had a positive
HCV antibody, giving a prevalence of 3.0%. This was a statistically significant difference (p
= 0.042, Fisher exact). Twelve (92.3%) of the subjects with a positive HCV antibody were
aged five years or more, while all 4 (100%) of those with a positive HCV antibody in the
control group were also aged five years or more. This suggested age to be an important factor
in HCV antibody positivity in both the subject and control groups. There was no statistically
significant difference between rates of HCV antibody positivity by gender in the study
subjects and controls. (p = 1.000, Fisher exact test).
Injection at patent medicine vendor was noted to be the most risky practice leading to
HCV antibody positivity in study subjects and controls, with more than thrice the chances of
a positive HCV antibody than in those who didn’t receive injections at PMV. Similarly, other
risk factors for a positive HCV antibody observed were tribal marks (RR = 1.12), tattoos (RR
= 1.07), uvulectomy (RR = 1.22) and circumcision (RR = 1.39). Another risk factor observed
in the study was the mode of delivery with children delivered vaginally found to be 1.6 times
more likely to have positive HCV antibody than those delivered via C/S. Likewise, breastfed
children were 1.18 times as likely to have a positive HCV antibody as non-breastfed peers.
Other potential risk factors identified were maternal HIV and HCV infections. Children of
HIV infected mothers were more than twice as likely to have a positive HCV antibody as
children of HIV negative mothers (RR = 2.67). Similarly, HCV infected mothers have 12%
greater chance of having children with positive HCV antibody than non-infected mothers.
In conclusion, this study has shown the prevalence of HCV antibody in HIV-infected
children to be significantly higher than that of HIV uninfected peers. The study also
identified risk factors associated with HCV antibody positivity as injections at patent
medicine vendor and to a less extent certain cosmetic, religious and cultural practices that
entail the use of sharps or incisions as well as maternal HIV and HCV infections.
It was therefore recommended that routine screening of HIV infected children for HCV
be instituted to identify co-infected children for prompt and appropriate treatment. Avoidance
of indiscriminate unsafe injections at patent medicine stores and modification and regulation
of certain cosmetic, religious or cultural practices involving the use of blades or other sharps
were also recommended.

PREVALENCE OF HEPATITIS C ANTIBODY IN HUMAN IMMUNODEFICIENCY VIRUS INFECTED CHILDREN AGED 2 – 15 YEARS AT AHMADU BELLO UNIVERSITY TEACHING HOSPITAL ZARIA