Epidemiology

Chronic hepatitis common in children with HIV

Last Updated: 2007-09-25 17:41:23 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Hepatitis B and C virus infections are common in children infected with HIV, who should be routinely screened for these infections, according to a report in the September 15th issue of Clinical Infectious Diseases.

"In the U.S. we are fortunate in that children and adolescents with HIV are living healthier and longer lives," Dr. Sima Shelly Toussi from Children's Hospital at Montefiore in the Bronx, New York told Reuters Health. "Yet research and expertise are lagging when it comes to management of chronic hepatitis in children."

Dr. Toussi and associates investigated the prevalence and features of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection in a group of inner city children infected with HIV.

Among 228 HIV-infected children and adolescents, 7 (3.1%) had chronic HCV infection and 6 (2.6%) had chronic HBV infection, the authors report.

This prevalence of chronic HCV is at least 10 times that of the general U.S. pediatric population, the researchers note, and the prevalence of chronic HBV in this group is more than 6 times that of the pediatric population.

Coinfected patients were, on average, about 5 years older than monoinfected patients, and no new perinatal HCV or HBV transmission has been seen in the past decade.

"The lower number of documented cases of chronic HCV infection among younger, HIV-exposed birth cohorts indicates the effects of universal screening of blood donors and the expanded use of HAART during pregnancy," the investigators point out.

A third of coinfected patients acquired HBV and HIV infections through blood transfusions, whereas 99% of monoinfected children acquired HIV vertically.

Children with HBV or HCV coinfection were far more likely than monoinfected children to have advanced HIV disease, the investigators say, and were more likely to have lower CD4 cell percentages and higher HIV-1 RNA loads.

"In the past 15 years, we have witnessed a remarkable decrease in the rate of perinatal acquisition of HCV and HBV infection," the authors conclude. "Nonetheless, given the high prevalence of coinfection documented in this cohort, it would be prudent to screen all HIV-infected adolescents for viral hepatitis."

"The HBV and HCV coinfection rates are likely far higher in Asia and Africa," Dr. Toussi said. "This is ultimately because of the inability to screen blood products and the lack of access to the HBV vaccine in the developing world."

Clin Infect Dis 2007;45:795-798.