Abstract
BackgroundThe endemicity of hepatitis B virus (HBV) prompted the systematic immunization of newborns in Cameroon since 2005. In the frame of a considerable burden of HIV/HBV co-infection (17.5%), monitoring HBV among children living with HIV (CLHIV) would guide toward HIV/HBV integrated paediatric care. We sought to ascertain the prevalence and determinants of HBV infection in the population of CLHIV and performance of commonly used rapid diagnosis tests (RDTs).MethodsCross-sectional study conducted from February through June 2017 in a subset of CLHIV ≤15 years old at the Essos Hospital Centre, Yaounde, Cameroon. HBV was tested by HBsAg ELISA sandwich in duplicates for each sample, and the mean optical density was calculated. The Determinants of HBV-prevalencewere evaluated, and p < 0.05 was the significance threshold. The performance of two HBV RDTs (Diaspot vs. HBV-5) was evaluated in comparison to ELISA (used as gold standard).ResultsOf the 83 CLHIV enrolled (54.2% female, mean age 8.7 [±3.8] years, 60% vaccinated against HBV, all breastfed), HBV-prevalence was 2.41% (2/83). HBV-positivity was significantly associated with unknown maternal HBV status (2.9% [2/69] vs. 0.0% [0/14], p = 0.0097) and vaginal delivery (2.4% [2/82] vs. 0.0% [0/1], p = 0.0018). Moreover, the most likely to be positive were aged 11 and 15 years, and had experienced neither anti-HBV vaccination nor anti-HBV serum administration, and both had not been treated with any antiseptic solution at birth. Regarding the performance of Diaspot vs. HBV-5 respectively, sensitivity was 100% (2/2) vs. 50% (1/2), while specificity was 100% (45/45) vs. 97.8% (44/45); positive and negative predictive values of Diaspot versus HBV-5 were respectively 100% (2/2) and 100% (45/45) versus 50% (1/2) and 97.8% (44/45).ConclusionHBV-infection in the population of CLHIV appears at a moderate prevalence, suggesting a decreased burden likely due to preventive measures including the wide vaccine coverage. Focusing on mothers with unknown HBV status and promoting safer delivery mode (caesarean section) for HBV-positive motherswould contribute toward pediatric HBV elimination. In context of limited resources, Diaspot test appears more reliable to rollout HBV-infection in the population of CLHIV. As findings are limited to a small sample size, studies on a wider population would be relevant.
Highlights
HIV and hepatitis B virus (HBV) remain major public health concerns worldwide, with about 36.9 and 350 million people living respectively with HIV and chronic HBV (CHB) infections worldwide [1, 2]
The probability of acquiring CHB is significantly higher in the frame of HIV infection, and this event becomes more worrisome for children at early age (80–90% of infants aged below 1 year and 30–50% of children aged 1–4 years) infected with HBV end-up developing CHB infection [4, 5]
“children detected positive for hepatitis B surface antigen (HBsAg) and envelope antigen (HBeAg) are highly contagious; over 85–90% of them are potential CHB carriers and liver cancer patients at adulthood, a condition that would be worsening in the context of co-infection with HIV [10,11,12]
Summary
HIV and hepatitis B virus (HBV) remain major public health concerns worldwide, with about 36.9 and 350 million people living respectively with HIV and chronic HBV (CHB) infections worldwide [1, 2]. “children detected positive for hepatitis B surface antigen (HBsAg) and envelope antigen (HBeAg) are highly contagious; over 85–90% of them are potential CHB carriers and liver cancer patients at adulthood, a condition that would be worsening in the context of co-infection with HIV [10,11,12] In this context, ensuring an effective implementation of a preventive package would be helpful, starting from universal screening of HBV among pregnant women attending their first antenatal care (ANC), a systematic vaccination against HBV all pregnant women having a negative HBsAg result, providing HBV antibodies at birth to all vertically-exposed babies, and a universal vaccination of new-borns [13]. We sought to ascertain the prevalence and determinants of HBV infection in the population of CLHIV and performance of commonly used rapid diagnosis tests (RDTs)
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