HEPATITIS B SURFACE ANTIGENAEMIA IN HUMAN IMMUNODEFICIENCY VIRUS INFECTED CHILDREN AGED 18 MONTHS TO 15 YEARS AT THE UNIVERSITY OF NIGERIA TEACHING HOSPITAL ITUKU-OZALLA, ENUGU

Abstract

All over the world, human immunodeficiency virus and Hepatitis B virus infections, have
reached pandemic proportions, especially in sub-Saharan Africa and Asia. Infection with both
viruses poses treatment challenges and is a major public health concern as both viruses share
common modes of transmission with tendency to chronicity. The resulting liver disease is
accelerated by the initiation of HAART (Highly Active Antiretroviral Therapy) and longer
duration of survival of these children may promote the emergence of complications of liver
disease.
The aims of the study were then to ascertain the prevalence of HBsAg among HIV infected
children, determine the role of the risk factors in HBV transmission in co-infected children
and to assess for liver disease and worsening immunosuppression among these groups of
children.
One hundred and forty HIV infected children aged 18 months to 15 years attending the
antiretroviral clinic at the University of Nigeria Teaching Hospital, Ituku-Ozalla were
enrolled while 140 children without HIV infection attending children out-patient clinic
matched for age and sex served as controls. Their sera were analysed for HBsAg using a
rapid immunochromatographic enzyme immunoassay (Determine HBsAg test kit) with
principles similar to ELISA and a sensitivity of 94.6%. Risk factors assessed included
histories of previous blood transfusion, use of contaminated syringes and needles for
injection, circumcision, intravenous drug use, scarification, tattooing, sharing of toothbrush
and unprotected sex, as well as histories of HB immunization, using an interviewer
questionnaire. The recent, as well as the baseline liver function and CD4 count/CD4% values
of HIV positive children at the time of the study were obtained.

Fourteen of the HIV infected as well as six of the controls were positive for HBsAg giving a
prevalence rate of 10% and 4.3% respectively (p = 0.10) indicating that HBV infection is
commoner among HIV infected individuals compared with the general population. The
prevalence rates among the HIV infected males was 13.5% and 6.1% among the females (p >
0.05). The prevalence of HBsAg was zero in children aged 18 months to 36 months in both
study and control population suggesting that vertical transmission may, probably, not be a
major mode of transmission of HBV in our environment. Sharing of tooth brush among
siblings was found to be statistically significant among HIV negative children, though blood
transfusion, scarification and circumcision all carried higher risk of transmitting HBV
infection.
Hepatitis B virus co-infection was associated with lower baseline median CD4 count and
remained so after the initiation of HAART. It was also associated with mild liver disease
which may have been exacerbated by HAART.
Strengthening of childhood universal HB immunization, creating public awareness/health
education will help eradication of HBV infection irrespective of HIV status of the children.
Further research is required to determine other remote risk factors that may influence HBV
transmission among HIV positive individuals.

HEPATITIS B SURFACE ANTIGENAEMIA IN HUMAN IMMUNODEFICIENCY VIRUS INFECTED CHILDREN AGED 18 MONTHS TO 15 YEARS AT THE UNIVERSITY OF NIGERIA TEACHING HOSPITAL ITUKU-OZALLA, ENUGU