Frequent Occurrence of Chronic Hepatitis B Virus Infection among West African HIV Type-1—Infected Children

The aim of this study conducted in Ivory Coast was to evaluate the prevalence and evolution of viral hepatitis in children coinfected with human immunodeficiency virus type 1 (HIV-1). Hepatitis B virus (HBV) and hepatitis C virus (HCV) markers were retrospectively and longitudinally assessed among 280 HIV-1-infected children enrolled in the Agence Nationale de Recherches sur le SIDA et les Hepatites Virales B et C 1244/1278 cohort. Among these 173 (61.8%) received highly active antiretroviral therapy (HAART) including lamivudine (3TC) for 122 children. Detection of the hepatitis B s antigen (HBsAg) was performed on specimens collected at inclusion and 6 months later. If results of both tests were positive hepatitis B e antigen (HBeAg)/hepatitis B e antibody (HBeAb) and HBV DNA levels were measured at inclusion and during follow-up. A fourth-generation HCV enzyme immunoassay was used for HCV screening at inclusion. In our pediatric cohort no patients were infected with HCV but the prevalenceof HBsAg at inclusion was 12.1% (34 of 280; 95% confidence interval [CI] 8.6-16.6). Among the HBV-HIV-1-coinfected children a high rate of positive HBeAg chronic hepatitis B (CHB) was noted at inclusion (82.4% [28 of 34]; 95% CI 65.5%-93.2%) and after a median follow-up of 18 months (78.3%; 95% CI 45.5%-92.7%) with no significant difference between children treated with HAART (with or without 3TC) and untreated ones. These children showed high HBV DNA levels (usually 18.0 log10 copies/mL) and viral population consisting of nearly exclusively wild-type HBeAg-positive HBV strains strongly suggesting that most of them were in the initial immunotolerant phase of chronic hepatitis B. In sub-Saharan Africa children with chronic hepatitis B and who are treated with 3TC-based HAART are at risk of developing 3TC resistance. Further studies are required to guide the management of HBV-HIV-1-coinfected children. (authors)