High Prevalence of Hepatitis B Virus Markers in Romanian Adolescents With Human Immunodeficiency Virus Infection

Simona Maria Ruta, MD, PhD; Rodica Floarea Matusa, MD, PhD; Camelia Sultana, MD; Loredana Manolescu, MD; Claudia A. Kozinetz, PhD; Mark W. Kline, MD; Costin Cernescu, MD, PhD

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Abstract and Introduction

Background. We evaluated the frequency of hepatitis coinfection in Romanian adolescents who were diagnosed with human immunodeficiency virus (HIV) infection prior to 1995.

Methods. One hundred sixty-one adolescents (13-18 years of age) with symptomatic HIV infection, but without signs of hepatic dysfunction, and 356 age-matched, HIV-uninfected controls underwent laboratory testing for markers of parenterally acquired hepatitis virus infection.

Results. Seventy-eight percent of HIV-infected adolescents had markers of past or present hepatitis B virus (HBV) infection, as compared with 32% of controls ( P = .0001). The prevalence of HBV replicative markers was more than 5-fold higher in HIV-infected adolescents as compared with controls: 43.4% vs 7.9% ( P = .0001), respectively, for hepatitis B surface antigen (HBsAg); and 11.2% vs 2.2% ( P = .0001), respectively, for hepatitis B e antigen (HBeAg). The prevalence of HBsAg chronic carriers and the presence of HBV replicative markers was significantly higher in patients with immunologically defined AIDS (CD4+ cell counts< 200 cells/mcL): 59.6% vs 34.6% ( P = .02) for HBsAg and 22.8% vs 5.7 %, ( P = .002) for HBV DNA. After 1 year of follow-up, the proportion of those who cleared the HBeAg was considerably lower in severely immunosuppressed coinfected patients: 4.7% vs 37.1% ( P = .003). Four additional HIV-infected adolescents became HBsAg-positive over the term of follow-up (incidence rate, 24.9/1000 person-years), despite a record of immunization against hepatitis B.

Conclusions. A substantial percentage of HIV-infected and HIV-uninfected Romanian adolescents have evidence of past or present HBV infection. In HIV-infected adolescents, the degree of immunosuppression is correlated with persistence of HBV replicative markers, even in the absence of clinical or biochemical signs of liver disease.

Through the end of 2003, Romania had reported 9936 pediatric HIV/AIDS cases, representing an important part of all European pediatric HIV/AIDS cases. Most of these children became infected with HIV between 1988 and 1992 through the use of blood and blood products unscreened for HIV antibodies, and the use and reuse of disposable needles and syringes in hospitals and institutions.[1]

Because of the shared routes of transmission, Romanian children and adolescents with horizontally acquired HIV infection also may be at substantial risk for infection with hepatitis B virus (HBV) and hepatitis C virus (HCV). Although nosocomial transmission of these viruses in Romania has been almost completely eliminated, children and adolescents infected with HIV and/or HBV soon will be sexually active (if they are not already), and could pose substantial public health risks. In addition, coinfection with HIV and HBV has potential implications for the safety and effectiveness of antiretroviral therapy. Assessing the changing incidence and prevalence of viral hepatitis markers in a cohort of HIV-infected adolescents allows us to gauge the impact of HIV infection on the course of HBV infection. In this study we report the prevalence of HBV infection markers in a cohort of 161 HIV-infected adolescents with HIV infection acquired prior to 1995. Our objectives were to evaluate the influence of HIV disease status and level of immunosuppression on clearance of HBV infection, and to assess the impact of HIV/HBV coinfection on the occurrence of subclinical hepatic dysfunction.

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