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Makokha GN, Zhang P, Hayes CN, Songok E, Chayama K. The burden of Hepatitis B virus infection in Kenya: A systematic review and meta-analysis. Front Public Health 2023; 11:986020. [PMID: 36778557 PMCID: PMC9909240 DOI: 10.3389/fpubh.2023.986020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 01/10/2023] [Indexed: 01/27/2023] Open
Abstract
Background Chronic Hepatitis B virus (HBV) infection causes liver cirrhosis and cancer and is a major public health concern in Kenya. However, so far no systematic review and meta-analysis has been conducted to estimate the burden of disease in the country. A better understanding of HBV infection prevalence will help the government implement efficient strategies at eliminating the disease. This systematic review and meta-analysis was therefore conducted to summarize and update the available information on the burden of HBV in Kenya. Method We systematically searched PubMed, Science Direct, Web of Science, Scopus, African Journals OnLine, and Google Scholar databases to retrieve primary studies conducted between January 1990 and June 2021 that assessed the prevalence of HBV infection in Kenya based on measurement of the Hepatitis B Surface Antigen (HBsAg). Meta-analysis was performed using the random effects model where HBsAg prevalence was estimated at a 95% confidence interval (CI) after simple pooling analysis. Potential sources of heterogeneity were also investigated. Results Fifty studies were included in the meta-analysis with a sample size of 108448. The overall pooled prevalence estimate of HBV in Kenya was 7.8% (95% CI: 5.8-10.1). Subgroup analysis revealed the highest prevalence among patients presenting with jaundice at 41.7% (95% CI: 13.5-73.3) whereas blood donors had the lowest prevalence at 4.1% (95% CI: 2.4-6.3). Prevalence in Human Immunodeficiency Virus (HIV)-infected individuals was 8.2% (95% CI: 5.8-11.0). An estimate of the total variation between studies revealed substantial heterogeneity (I2 = 99%) which could be explained by the study type, the risk status of individuals, and the region of study. Conclusion We present the first systematic review and meta-analysis of the prevalence of HBV in Kenya. Our results show that the burden of HBV in Kenya is still enormous. This calls for an urgent need to implement public health intervention measures and strategic policies that will bring the disease under control and lead to final elimination. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=264859, identifier: CRD42021264859.
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Affiliation(s)
- Grace Naswa Makokha
- Laboratory of Medical Innovation, Department of Collaborative Research, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan,*Correspondence: Grace Naswa Makokha ✉
| | - Peiyi Zhang
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - C. Nelson Hayes
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Elijah Songok
- Graduate School of Health Sciences, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Kazuaki Chayama
- Laboratory of Medical Innovation, Department of Collaborative Research, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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2
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Yu Y, Wan Z, Wang JH, Yang X, Zhang C. Review of human pegivirus: Prevalence, transmission, pathogenesis, and clinical implication. Virulence 2022; 13:324-341. [PMID: 35132924 PMCID: PMC8837232 DOI: 10.1080/21505594.2022.2029328] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Human pegivirus (HPgV-1), previously known as GB virus C (GBV-C) or hepatitis G virus (HGV), is a single-stranded positive RNA virus belonging to the genus Pegivirus of the Flaviviridae family. It is transmitted by percutaneous injuries (PIs), contaminated blood and/or blood products, sexual contact, and vertical mother-to-child transmission. It is widely prevalent in general population, especially in high-risk groups. HPgV-1 viremia is typically cleared within the first 1–2 years of infection in most healthy individuals, but may persist for longer periods of time in immunocompromised individuals and/or those co-infected by other viruses. A large body of evidences indicate that HPgV-1 persistent infection has a beneficial clinical effect on many infectious diseases, such as acquired immunodeficiency syndrome (AIDS) and hepatitis C. The beneficial effects seem to be related to a significant reduction of immune activation, and/or the inhabitation of co-infected viruses (e.g. HIV-1). HPgV-1 has a broad cellular tropism for lymphoid and myeloid cells, and preferentially replicates in bone marrow and spleen without cytopathic effect, implying a therapeutic potential. The paper aims to summarize the natural history, prevalence and distribution characteristics, and pathogenesis of HPgV-1, and discuss its association with other human viral diseases, and potential use in therapy as a biovaccine or viral vector.
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Affiliation(s)
- Yaqi Yu
- College of Life Sciences, Henan Normal University, Xinxiang, China.,Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Zhenzhou Wan
- Medical Laboratory of Taizhou Fourth People's Hospital, Taizhou, China
| | - Jian-Hua Wang
- Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China
| | - Xianguang Yang
- College of Life Sciences, Henan Normal University, Xinxiang, China
| | - Chiyu Zhang
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
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3
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Lawal MA, Adeniyi OF, Akintan PE, Salako AO, Omotosho OS, Temiye EO. Prevalence of and risk factors for hepatitis B and C viral co-infections in HIV infected children in Lagos, Nigeria. PLoS One 2020; 15:e0243656. [PMID: 33301507 PMCID: PMC7728231 DOI: 10.1371/journal.pone.0243656] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 11/16/2020] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION The study was carried out to determine the prevalence of and risk factors for hepatitis B and C viral co-infections in HIV infected children in Lagos. METHOD A cross-sectional study conducted to determine the prevalence and risk factors for hepatitis B and C viral co-infection in children aged 2 months to 13 years. There were 187 HIV infected and 187 HIV naïve age, sex-matched controls. Blood samples of participants were assayed for the serologic markers [HBsAg, anti-HBc, and anti-HCV)] of HBV and HCV viral infections using the Enzyme-Linked Immunosorbent assay (ELISA) method. RESULT The prevalence of HBV infection using HBsAg was 5.3% and 4.8% (p = 0.814), among HIV-infected and HIV naïve children respectively, while using anti-HBc the prevalence was 7.0% and 7.5% (p = 0.842) among HIV- infected and HIV naïve children respectively. The prevalence of HCV infection among HIV- infected and HIV naive children were equal to 0.5% (p = 1.000). There was also no significant association with the identifiable risk factors (sharing of a toothbrush, sharing of needles, incision marks/tattoo, hepatitis B immunization status, history of blood transfusion, previous surgical operation, sexual exposure/abuse, history of jaundice, and genital circumcision) and the HBV and or HCV status among both groups of children. History of sexual exposure/abuse and history of jaundice were however found to be predictors of the presence of HBsAg among HIV infected children only, using a binary logistic regression model. CONCLUSION The prevalence of HBV and or HCV infection among HIV-infected children is similar to the prevalence among HIV naïve children, suggesting that HIV-infected children are not more predisposed to viral hepatitis than healthy children. Also, there was no significant difference in the prevalence of HBV infection irrespective of the use of HBsAg or anti-HBc.
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Affiliation(s)
- Mary Adetola Lawal
- Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Oluwafunmilayo Funke Adeniyi
- Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
- Department of Paediatrics, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Patricia Eyanya Akintan
- Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
- Department of Paediatrics, College of Medicine, University of Lagos, Lagos, Nigeria
| | | | | | - Edamisan Olusoji Temiye
- Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
- Department of Paediatrics, College of Medicine, University of Lagos, Lagos, Nigeria
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4
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Skipper C, Schleiss MR, Bangdiwala AS, Hernandez-Alvarado N, Taseera K, Nabeta HW, Musubire AK, Lofgren SM, Wiesner DL, Rhein J, Rajasingham R, Schutz C, Meintjes G, Muzoora C, Meya DB, Boulware DR. Cytomegalovirus Viremia Associated With Increased Mortality in Cryptococcal Meningitis in Sub-Saharan Africa. Clin Infect Dis 2020; 71:525-531. [PMID: 31504335 PMCID: PMC7384323 DOI: 10.1093/cid/ciz864] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 08/30/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Cryptococcal meningitis and tuberculosis are both important causes of death in persons with advanced human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS). Cytomegalovirus (CMV) viremia may be associated with increased mortality in persons living with HIV who have tuberculosis. It is unknown whether concurrent CMV viremia is associated with mortality in other AIDS-related opportunistic infections. METHODS We prospectively enrolled Ugandans living with HIV who had cryptococcal meningitis from 2010-2012. Subsequently, we analyzed stored baseline plasma samples from 111 subjects for CMV DNA. We compared 10-week survival rates among those with and without CMV viremia. RESULTS Of 111 participants, 52% (58/111) had detectable CMV DNA (median plasma viral load 498 IU/mL, interquartile range [IQR] 259-2390). All samples tested were positive on immunoglobin G serology. The median CD4+ T cell count was 19 cells/µL (IQR 9-70) and did not differ by the presence of CMV viremia (P = .47). The 10-week mortality rates were 40% (23/58) in those with CMV viremia and 21% (11/53) in those without CMV viremia (hazard ratio 2.19, 95% confidence interval [CI] 1.07-4.49; P = .03), which remained significant after a multivariate adjustment for known risk factors of mortality (adjusted hazard ratio 3.25, 95% CI 1.49-7.10; P = .003). Serum and cerebrospinal fluid cytokine levels were generally similar and cryptococcal antigen-specific immune stimulation responses did not differ between groups. CONCLUSIONS Half of persons with advanced AIDS and cryptococcal meningitis had detectable CMV viremia. CMV viremia was associated with an over 2-fold higher mortality rate. It remains unclear whether CMV viremia in severely immunocompromised persons with cryptococcal meningitis contributes directly to this mortality or may reflect an underlying immune dysfunction (ie, cause vs effect). CLINICAL TRIALS REGISTRATION NCT01075152.
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Affiliation(s)
- Caleb Skipper
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Infectious Disease Institute, Makerere University, Kampala, Uganda
| | - Mark R Schleiss
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | | | | | - Kabanda Taseera
- Department of Medicine, Mbarara University of Science and Technology, Uganda
| | - Henry W Nabeta
- Infectious Disease Institute, Makerere University, Kampala, Uganda
| | - Abdu K Musubire
- Infectious Disease Institute, Makerere University, Kampala, Uganda
| | - Sarah M Lofgren
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Darin L Wiesner
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Joshua Rhein
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Infectious Disease Institute, Makerere University, Kampala, Uganda
| | | | - Charlotte Schutz
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, and Department of Medicine, University of Cape Town, South Africa
| | - Graeme Meintjes
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, and Department of Medicine, University of Cape Town, South Africa
| | - Conrad Muzoora
- Department of Medicine, Mbarara University of Science and Technology, Uganda
| | - David B Meya
- Infectious Disease Institute, Makerere University, Kampala, Uganda
| | - David R Boulware
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
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Anyanwu NCJ, Sunmonu PT, Mathew MH. Viral hepatitis B and C co-infection with Human Immunodeficiency Virus among adult patients attending selected highly active anti-retroviral therapy clinics in Nigeria's capital. J Immunoassay Immunochem 2019; 41:171-183. [PMID: 31880494 DOI: 10.1080/15321819.2019.1705852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Hepatitis B and C are liver diseases caused by hepatitis B and C viruses, and co-infection in HIV-positive individuals is common, with increased mortality and morbidity. This study determined the seroprevalence of HIV co-infection with the two viruses among patients attending three major hospitals in the Federal Capital Territory, Nigeria. From February to July 2019, 311 sera samples were collected from HIV positive patients and screened for Hepatitis B and C infection. Immunochromatographic and ELISA techniques for HBsAg and HCV were used. Socio-demographic features and responses to risk factors were obtained using questionnaires. Patients' data and results obtained were analyzed with SPSS version 25. The prevalence of HIV/HBV/HCV, HIV/HBV, and HIV/HCV co-infection were 0.64%, 6.43%, and 3.86%, respectively. The triple infection and both co-infections were preponderant among females than males, with a prevalence rate of 0.64%, 3.85%, 2.57%, and 0%, 2.57%, 1.29%, respectively. People aged 31-40 years had the highest triple infection (0.64%) and HIV/HCV infection rate (2.57%), while patients aged 21-30 years had the highest HBV co-infection (3.22%) rates. Widowed patients had the most co-infection rate in all cases. High-risk behavior indicated that there was a significant association between blood donation/reception and engagement in unprotected sex and HIV/HBV/HCV co-infection. The other risk factors revealed no significant effect (p > .05). There was generally a low rate of exposure to associated risk factors. This study highlighted the endemicity of hepatitis virus co-infection in Abuja and the existence of few reports of HIV co-infection with HBV and HCV compared to the nation's population.
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Anoh AE, Mossoun A, Akoua-Koffi C, Couacy-Hymann E, Pauly M, Leendertz SA, Kouakou N'goran E, Schubert G, Weiss S, Hofmann J, Leendertz FH, Ehlers B. Seroprevalence of Cytomegalovirus Infection Among a Rural Population of Côte d'Ivoire. Viral Immunol 2018; 30:54-57. [PMID: 28055519 DOI: 10.1089/vim.2016.0044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Human cytomegalovirus (HCMV) is a betaherpesvirus that can be pathogenic to humans. In particular, immunocompromised patients can develop life-threatening symptoms. In the present study, HCMV seroprevalence was investigated in a rural population of Western Côte d'Ivoire. Plasma samples collected from 166 apparently healthy subjects living in 8 villages surrounding the Taï Forest National Park were tested for anti-HCMV immunoglobulin G and M antibody with two commercial enzyme-linked immunosorbent assays. Prevalence of anti-HCMV IgG and IgM antibody was 100% and 5.4%, respectively. Anti-HCMV IgM positive was 10.2% (5/49) of the children and adolescents and 3.4% (4/117) of the adults. This observed decrease of IgM seropositivity and the seroprevalence difference between males and females (3.8% vs. 6.1%) was not statistically significant. In plasma of one IgM-positive participant, a low CMV load was detected indicating low-level replication. A second IgM-positive participant showed signs of local CMV replication. The other seven IgM-positive plasma samples likely reacted nonspecifically or due to polyclonal stimulation. Taken together, the results indicate that HCMV infection is hyperendemic in Côte d'Ivoire.
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Affiliation(s)
- Augustin Etile Anoh
- 1 CHU de Bouaké/Centre de Recherche pour le Développement, Université Alassane Ouattara de Bouake , Bouake, Côte d'Ivoire.,2 UFR Biosciences, Université Félix Houphouët Boigny , Abidjan, Côte d'Ivoire
| | - Arsène Mossoun
- 2 UFR Biosciences, Université Félix Houphouët Boigny , Abidjan, Côte d'Ivoire.,3 LANADA/Laboratoire Central de Pathologie Animale , Bingerville, Côte d'Ivoire
| | - Chantal Akoua-Koffi
- 1 CHU de Bouaké/Centre de Recherche pour le Développement, Université Alassane Ouattara de Bouake , Bouake, Côte d'Ivoire
| | | | - Maude Pauly
- 4 Project P3 "Epidemiology of Highly Pathogenic Microorganisms," Robert Koch Institute, Berlin, Germany .,5 Division 12 "Measles, Mumps, Rubella and Viruses Affecting Immune-Compromised Patients," Robert Koch Institute, Berlin, Germany
| | - Siv-Aina Leendertz
- 4 Project P3 "Epidemiology of Highly Pathogenic Microorganisms," Robert Koch Institute, Berlin, Germany
| | | | - Grit Schubert
- 4 Project P3 "Epidemiology of Highly Pathogenic Microorganisms," Robert Koch Institute, Berlin, Germany
| | - Sabrina Weiss
- 4 Project P3 "Epidemiology of Highly Pathogenic Microorganisms," Robert Koch Institute, Berlin, Germany
| | - Jörg Hofmann
- 6 Labor Berlin, Department of Virology, and Institut of Medical Virology, Charité University Medicine Berlin , Berlin, Germany
| | - Fabian H Leendertz
- 4 Project P3 "Epidemiology of Highly Pathogenic Microorganisms," Robert Koch Institute, Berlin, Germany
| | - Bernhard Ehlers
- 5 Division 12 "Measles, Mumps, Rubella and Viruses Affecting Immune-Compromised Patients," Robert Koch Institute, Berlin, Germany
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Singh S, Blackard JT. Human pegivirus (HPgV) infection in sub-Saharan Africa-A call for a renewed research agenda. Rev Med Virol 2017; 27. [PMID: 29148108 DOI: 10.1002/rmv.1951] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 08/26/2017] [Accepted: 08/28/2017] [Indexed: 12/14/2022]
Abstract
The human pegivirus (HPgV)-formerly GB virus C-has a beneficial impact on HIV disease progression that has been described in multiple studies. Given the high prevalence of HIV in sub-Saharan Africa and the continuing need to suppress HIV replication, this review provides a comprehensive overview of the existing data on HPgV infection in sub-Saharan Africa, with a particular focus on studies of prevalence and the circulating HPgV genotypes. This review also highlights the need for additional studies of HPgV conducted on the African continent and proposes a research agenda for evaluation of HPgV.
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Affiliation(s)
- Shivank Singh
- Division of Digestive Diseases, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jason T Blackard
- Division of Digestive Diseases, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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8
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Liu Z, Fang Q, Zuo J, Chen Y, Minhas V, Wood C, Zhang T. Global epidemiology of human herpesvirus 8 in men who have sex with men: A systematic review and meta-analysis. J Med Virol 2017; 90:582-591. [PMID: 28975631 DOI: 10.1002/jmv.24960] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 09/17/2017] [Indexed: 11/06/2022]
Abstract
Men who have sex with men (MSM) were highly vulnerable to HIV/AIDS and Human herpes virus 8 (HHV8), while the epidemiologic features of HHV8 among MSM remain obscure. We therefore performed a systematic review and meta-analysis to assess the burden of HHV8 in MSM. Electronic databases were searched for publications on HHV8 epidemiologic characteristics among MSM. Random-effect meta-analysis was applied to combine the HHV8 seroprevalence in MSM and odds ratios (ORs) for associated risk factors. Meta-regression and stratified analyses were performed to detect the potential sources of heterogeneity. The pooled HHV8 seroprevalence in MSM was 33.0% (95%CI 29.2%-37.1%). Significant factors associated with HHV8 included HIV (OR 3.70, 95%CI 2.93-4.67), STDs (OR 2.32, 95%CI 1.82-2.97), and high risk sexual behaviors (OR 1.50, 95%CI 1.17-1.92). Race (OR 1.44, 95%CI 0.94-2.12) and multiple sexual partners (OR 1.61, 95%CI 0.95-2.72) were also associated with HHV8 (P < 0.10). We found no significant association between IDU and HHV8 (OR 1.44, 95%CI 0.06-32.47). HHV8 is highly prevalent among MSM and the high risk behaviors may facilitate the transmission of this virus. This situation could be of significant public health importance, especially in the context of HIV coinfection.
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Affiliation(s)
- Zhenqiu Liu
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China.,Key Laboratory of Public Health Safety (Fudan University), Ministry of Education, Shanghai, China
| | - Qiwen Fang
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China.,Key Laboratory of Public Health Safety (Fudan University), Ministry of Education, Shanghai, China
| | - Jialu Zuo
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China.,Key Laboratory of Public Health Safety (Fudan University), Ministry of Education, Shanghai, China
| | - Yue Chen
- Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Veenu Minhas
- Nebraska Center of Virology and the School of Biological Sciences, University of Nebraska-Lincoln, Lincoln, Nebraska
| | - Charles Wood
- Nebraska Center of Virology and the School of Biological Sciences, University of Nebraska-Lincoln, Lincoln, Nebraska
| | - Tiejun Zhang
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China.,Key Laboratory of Public Health Safety (Fudan University), Ministry of Education, Shanghai, China
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9
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Grønborg HL, Jespersen S, Hønge BL, Jensen-Fangel S, Wejse C. Review of cytomegalovirus coinfection in HIV-infected individuals in Africa. Rev Med Virol 2016; 27. [PMID: 27714898 DOI: 10.1002/rmv.1907] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 08/25/2016] [Accepted: 08/26/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Cytomegalovirus (CMV) infection among HIV-infected individuals may cause end-organ disease, which is an AIDS-defining condition. Evidence from high-income countries suggests that CMV may alter the outcome of HIV infection, other than causing end-organ diseases. We reviewed literature on HIV and CMV coinfection in Africa. METHODS Systematic review of published studies on HIV and CMV coinfection in Africa using the PubMed database. RESULTS High CMV seroprevalence was found throughout Africa, exceeding 90% in most populations. Retinitis, pneumonia, and colitis were the most commonly reported CMV manifestations in HIV-infected individuals. Among patients with pulmonary symptoms, the prevalence of CMV pneumonitis varied from 20% to over 60%, whereas CMV was found in 0% to 14% of patients with gastrointestinal manifestations. Cytomegalovirus retinitis was found in 0% to 2.6% of examined HIV-infected individuals. The diagnostics of CMV end-organ diseases were found complex and difficult to interpret in African settings. Cytomegalovirus viremia was correlated with significantly lower CD4 cell count and increase in activated and apoptosis vulnerable T-lymphocytes. Also, CMV coinfection was found to be associated with increased transmission and progression of HIV infection. Moreover, detectable CMV DNA was an independent predictor of HIV transmission and mortality among HIV-infected individuals. CONCLUSIONS Cytomegalovirus is highly prevalent in Africa and a common cause of disease manifestations in HIV-infected individuals among all age groups. Cytomegalovirus coinfection in HIV-infected individuals in Africa is associated with increased transmission and mortality of HIV, but it is a neglected area of research.
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Affiliation(s)
- Helene Ladefoged Grønborg
- GloHAU, Department of Public Health, Global Health, Aarhus University, Aarhus N, Denmark.,Department of Infectious Diseases, Aarhus University Hospital, Aarhus N, Denmark.,Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau
| | - Sanne Jespersen
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus N, Denmark.,Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau
| | - Bo Langhoff Hønge
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus N, Denmark.,Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau.,Department of Clinical Immunology, Aarhus University Hospital, Aarhus N, Denmark
| | - Søren Jensen-Fangel
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus N, Denmark
| | - Christian Wejse
- GloHAU, Department of Public Health, Global Health, Aarhus University, Aarhus N, Denmark.,Department of Infectious Diseases, Aarhus University Hospital, Aarhus N, Denmark.,Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau
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11
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Varo R, Chris Buck W, Kazembe PN, Phiri S, Andrianarimanana D, Weigel R. Seroprevalence of CMV, HSV-2 and HBV among HIV-Infected Malawian Children: A Cross-sectional Survey. J Trop Pediatr 2016; 62:220-6. [PMID: 26884443 PMCID: PMC4912665 DOI: 10.1093/tropej/fmv105] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Little is known about viral co-infections in African human immunodeficiency virus (HIV)-infected children. We examined the prevalence of seromarkers for cytomegalovirus (CMV), herpes simplex virus type 2 (HSV-2) and hepatitis B virus (HBV) infections among HIV-infected, antiretroviral treatment (ART)-naïve children in Lilongwe, Malawi. METHODS Ninety-one serum samples were tested for IgG and IgM antibodies to CMV, and IgG antibodies to HSV-2 and hepatitis B surface antigen (HBsAg). Baseline demographic, clinical and laboratory data were abstracted from electronic records. RESULTS CMV IgG was the most common positive result in all age groups (in 73% of children <1 year, and 100% in all other groups). Three patients were CMV IgM positive (3.3%), suggesting acute infection. HSV-2 IgG was positive in four patients (4.4%), and HBsAg in two (2.2%). CONCLUSIONS CMV infection occurred early in life, and few children had specific signs of CMV infection at the time of ART initiation. Unrecognized HBV infection represents opportunities for testing and treatment of HIV/HBV co-infected children.
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Affiliation(s)
- Rosauro Varo
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique Barcelona Institute for Global Health (IS Global), Barcelona, Spain
| | - W. Chris Buck
- University of California Los Angeles, David Geffen School of Medicine, Maputo, Mozambique,Baylor College of Medicine Abbott Fund Children’s Clinical Centre of Excellence, Lilongwe, Malawi
| | - Peter N. Kazembe
- Baylor College of Medicine Abbott Fund Children’s Clinical Centre of Excellence, Lilongwe, Malawi
| | | | | | - Ralf Weigel
- Liverpool School of Tropical Medicine, Liverpool, UK
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12
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Peebles K, Nchimba L, Chilengi R, Bolton Moore C, Mubiana-Mbewe M, Vinikoor MJ. Pediatric HIV-HBV Coinfection in Lusaka, Zambia: Prevalence and Short-Term Treatment Outcomes. J Trop Pediatr 2015; 61:464-7. [PMID: 26338421 PMCID: PMC4852213 DOI: 10.1093/tropej/fmv058] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Hepatitis B virus (HBV) is endemic in Africa, where it may occur as an HIV coinfection. Data remain limited on HIV-HBV epidemiology in Africa, particularly in children. Using programmatic data from pediatric HIV clinics in Lusaka, Zambia during 2011-2014, we analyzed the prevalence of chronic HBV coinfection (defined as a single positive hepatitis B surface antigen [HBsAg] test) and its impact on immune recovery and liver enzyme elevation (LEE) during the first year of antiretroviral therapy. Among 411 children and adolescents, 10.4% (95% confidence interval, 7.6-14.1) had HIV-HBV. Coinfected patients were more likely to have World Health Organization stage 3/4, LEE and CD4 <14% at care entry (all p < 0.05). During treatment, CD4 increases and LEE incidence were similar by HBsAg status. HBsAg positivity decreased (11.8% vs. 6.6%; p = 0.24) following HBV vaccine introduction. These findings support screening pediatric HIV patients in Africa for HBV coinfection. Dedicated cohorts are needed to assess long-term outcomes of coinfection.
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Affiliation(s)
- Kathryn Peebles
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lweendo Nchimba
- Department of Pediatrics, University Teaching Hospital, Lusaka, Zambia
| | - Roma Chilengi
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Carolyn Bolton Moore
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia,Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA,Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Michael J. Vinikoor
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia,Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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13
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Adland E, Klenerman P, Goulder P, Matthews PC. Ongoing burden of disease and mortality from HIV/CMV coinfection in Africa in the antiretroviral therapy era. Front Microbiol 2015; 6:1016. [PMID: 26441939 PMCID: PMC4585099 DOI: 10.3389/fmicb.2015.01016] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 09/08/2015] [Indexed: 12/17/2022] Open
Abstract
Human Cytomegalovirus (CMV) is a well-recognized pathogen in the context of HIV infection, but since the roll out of ART, clinical and scientific interest in the problem of HIV/CMV coinfection has diminished. However, CMV remains a significant cofactor in HIV disease, with an influence on HIV acquisition, disease progression, morbidity, and mortality. Disease manifestations may be a result of direct interplay between the two viruses, or may arise as a secondary consequence of immune dysregulation and systemic inflammation. The problem is most relevant when the rates of coinfection are high, most notably in sub-Saharan Africa, and in children at risk of acquiring both infections early in life. Understanding the interplay between these viruses and developing strategies to diagnose, treat and prevent CMV should be a priority.
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Affiliation(s)
- Emily Adland
- Department of Paediatrics, Peter Medawar Building for Pathogen Research, University of Oxford Oxford, UK
| | - Paul Klenerman
- Nuffield Department of Medicine, Peter Medawar Building for Pathogen Research, University of Oxford Oxford, UK ; Department of Infectious Diseases and Microbiology, John Radcliffe Hospital, Oxford University Hospitals NHS Trust Oxford, UK ; National Institute for Health Research Biomedical Research Centre Oxford, UK
| | - Philip Goulder
- Department of Paediatrics, Peter Medawar Building for Pathogen Research, University of Oxford Oxford, UK ; HIV Pathogenesis Programme, Doris Duke Medical Research Institute, University of KwaZulu-Natal Durban, South Africa
| | - Philippa C Matthews
- Nuffield Department of Medicine, Peter Medawar Building for Pathogen Research, University of Oxford Oxford, UK ; Department of Infectious Diseases and Microbiology, John Radcliffe Hospital, Oxford University Hospitals NHS Trust Oxford, UK
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Wang J, Liu S, Cao Y, Yang L, Chen Y, Minhas V, Wood C, Zhang T. Prevalence of Kaposi's sarcoma associated herpesvirus among men attending sexually transmitted infections clinics in Anhui, China. J Med Virol 2015; 88:304-11. [PMID: 26147809 DOI: 10.1002/jmv.24321] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2015] [Indexed: 11/06/2022]
Abstract
Kaposi's sarcoma-associated herpesvirus (KSHV) may be transmitted via sexual contacts, but limited information is available on KSHV infection status among sexually transmitted infection (STI) patients in China. The main objective of the present study was to determine the KSHV seroprevalence and its risk factors among male STI patients. A cross-sectional survey was conducted in three prefectures of Anhui province, China, between June and September 2013. A total of 1,600 male patients who visited an STI clinic were invited, and 1,372 participated in the study. Data were abstracted from the medical records for all the patients. Blood samples were collected and tested for antibodies to KSHV, HIV, HCV, and syphilis. Factors associated with KSHV seropositivity were examined using multivariable logistic regression analysis. The overall prevalence of KSHV, HIV, HCV, and syphilis was 13.3%, 0.7%, 0.6%, and 12.5%, respectively. After adjusting for potential confounders, KSHV infection was significantly associated with ever having anal sex with men (19 out of 30 males, OR: 8.64, 95%CI: 1.92-38.79) and HIV infection (six out of nine HIV-positive individuals, OR: 8.39, 95%CI: 1.80-39.04). There were no significant associations of KSHV infection with drug use, heterosexual sex behaviors, syphilis, and HCV. Our finding has shown that a relatively moderate prevalence of KSHV was found among male STI patients. While an increased risk for KSHV infection was observed among participants with homosexual contacts. Routine KSHV testing is recommended for male individuals attending STI clinics.
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Affiliation(s)
- Jun Wang
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China.,Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Shanghai, China
| | - Shuying Liu
- Anhui Provincial Institute of Dermatology and Venereology, Hefei, Anhui, China
| | - Yifei Cao
- School of Medicine, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Lei Yang
- School of Medicine, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Yue Chen
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ontario, Canada
| | - Veenu Minhas
- Nebraska Center of Virology, School of Biological Sciences, University of Nebraska-Lincoln, Lincoln, Nebraska
| | - Charles Wood
- Nebraska Center of Virology, School of Biological Sciences, University of Nebraska-Lincoln, Lincoln, Nebraska
| | - Tiejun Zhang
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China.,Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Shanghai, China
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Schaftenaar E, Verjans GMGM, Getu S, McIntyre JA, Struthers HE, Osterhaus ADME, Peters RPH. High seroprevalence of human herpesviruses in HIV-infected individuals attending primary healthcare facilities in rural South Africa. PLoS One 2014; 9:e99243. [PMID: 24914671 PMCID: PMC4051661 DOI: 10.1371/journal.pone.0099243] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 05/12/2014] [Indexed: 12/14/2022] Open
Abstract
Seroprevalence data of human herpesviruses (HHVs) are limited for sub-Saharan Africa. These are important to provide an indication of potential burden of HHV-related disease, in particular in human immunodeficiency virus (HIV)-infected individuals who are known to be at increased risk of these conditions in the Western world. In this cross-sectional study among 405 HIV-infected and antiretroviral therapy naïve individuals in rural South Africa the seroprevalence of HHVs was: herpes simplex virus type 1 (HSV-1) (98%), herpes simplex virus type 2 (HSV-2) (87%), varicella zoster virus (VZV) (89%), and 100% for both Epstein-Barr virus (EBV) and cytomegalovirus (CMV). Independent factors associated with VZV seropositivity were low educational status and having children. Lack of in-house access to drinking water was independently associated with positive HSV-1 serostatus, whereas Shangaan ethnicity was associated with HSV-2 seropositivity. Increasing age was associated with higher IgG titres to both EBV and CMV, whereas CD4 cell count was negatively associated with EBV and CMV IgG titres. Moreover, IgG titres of HSV-1 and 2, VZV and CMV, and CMV and EBV were positively correlated. The high HHV seroprevalence emphasises the importance of awareness of these viral infections in HIV-infected individuals in South Africa.
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Affiliation(s)
- Erik Schaftenaar
- Department of Viroscience, Erasmus Medical Center, Rotterdam, The Netherlands
- Anova Health Institute, Johannesburg and Tzaneen, South Africa
| | | | - Sarah Getu
- Department of Viroscience, Erasmus Medical Center, Rotterdam, The Netherlands
| | - James A. McIntyre
- Anova Health Institute, Johannesburg and Tzaneen, South Africa
- School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Helen E. Struthers
- Anova Health Institute, Johannesburg and Tzaneen, South Africa
- Department of Medicine, Division of Infectious Diseases & HIV Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Remco P. H. Peters
- Anova Health Institute, Johannesburg and Tzaneen, South Africa
- Department of Medical Microbiology, Maastricht University Medical Centre, Maastricht, The Netherlands
- * E-mail:
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16
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Muro FJ, Fiorillo SP, Sakasaka P, Odhiambo C, Reddy EA, Cunningham CK, Buchanan AM. Seroprevalence of Hepatitis B and C Viruses Among Children in Kilimanjaro Region, Tanzania. J Pediatric Infect Dis Soc 2013; 2:320-6. [PMID: 24363930 PMCID: PMC3869471 DOI: 10.1093/jpids/pit018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 01/24/2013] [Indexed: 12/14/2022]
Abstract
BACKGROUND Data on human immunodeficiency virus (HIV) and hepatitis B virus (HBV) and hepatitis C virus (HCV) coinfection among children in Africa are limited. We evaluated the seroprevalence of both viruses among healthy, HIV-uninfected children and HIV-infected children in the Kilimanjaro region of northern Tanzania. METHODS HBV and HCV markers were assessed using serum and plasma samples from HIV-negative children ages 1 month to 18 years, recruited primarily from 2 hospital vaccination clinics; and HIV-infected children 1-16 years of age, enrolled in care and on highly active antiretroviral therapy (HAART). HBV markers included hepatitis B surface antigen (HBsAg), hepatitis B surface antibody, and hepatitis B core antibody (HBcAb). Evidence of any prior HBV infection was defined as a single positive HBsAg or HBcAb result; presumed chronic hepatitis B infection was defined as a single positive HBsAg result. HCV infection was assessed by anti-HCV enzyme-linked immunosorbent assay. RESULTS Samples from 547 children were tested. Of 157 children infected with HIV, 9.6% (95% CI: 4.9, 14.2) showed evidence of any HBV infection, compared to 2.1% (95% CI: .6, 3.5) of HIV-negative children. Children with HIV were much more likely to show evidence of HBV infection than children without HIV (odds ratio [OR] = 5.0, P < .0001). Prevalence of presumed chronic HBV infection was 2.9% (95% CI: 1.5, 4.3) overall. Again, prevalence was higher among HIV-infected children (7.0% [95% CI: 3.0, 11.0]) compared to HIV-negative children (1.3% [95% CI: .2, 2.4]; OR = 5.8 [P = .0003]). Of 546 samples tested for anti-HCV antibody, none were positive. CONCLUSION HBV seroprevalence is high among children in the Kilimanjaro Region, with a significantly higher prevalence among children who are infected with HIV. Routine screening for HBV is needed among HIV-infected children. Patients with coinfection require closer monitoring of liver transaminases due to potential for hepatic toxicities, and they may need HAART regimens that will target both viruses. Guidelines for the management of coinfected children are urgently needed.
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Affiliation(s)
| | - Suzanne P. Fiorillo
- Division of Infectious Diseases, University of Colorado, Denver School of Medicine, Aurora
| | | | | | - Elizabeth A. Reddy
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania,Divison of Infectious Diseases, Department of Medicine, Duke University Medical Center,Duke Global Health Institute, Duke University
| | - Coleen K. Cunningham
- Division of Infectious Diseases, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Ann M. Buchanan
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania,Duke Global Health Institute, Duke University,Division of Infectious Diseases, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina,Corresponding Author: Ann M. Buchanan, MD, MPH, DTM&H, KCMC-Duke Collaboration, Kilimanjaro Christian Medical Centre, Box 3010, Moshi, Tanzania. E-mail:
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17
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Ikpeme EE, Etukudo OM, Ekrikpo UE. Seroprevalence of HBV and HIV co-infection in children and outcomes following highly active antiretroviral therapy (HAART) in Uyo, South-South Nigeria. Afr Health Sci 2013; 13:955-61. [PMID: 24940318 PMCID: PMC4056492 DOI: 10.4314/ahs.v13i4.14] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Human Immunodeficiency Virus/Hepatitis B Virus (HIV/HBV) co-infection in Nigerian children has emerged as a major concern with the advent of HAART. Its impact on the immune system and liver has not been extensively studied in children. OBJECTIVES To determine the prevalence of HBV seropositivity among HIV positive children on HAART and its effect on immune response and liver enzymes. METHODS All consecutive HIV positive children aged two months to seventeen years on HAART constituted the study population. Age and gender; CD4+ count, ALT, creatinine and HBsAg were tested and documented at enrolment and 12months. RESULTS One hundred and seventy one patients were seen over this period. Seventy-two (43.4%) were males while 94 (56.6%) were females giving a male: female ratio of 1:1.3. The mean age of the patients was 63±43.4 months. Prevalence of HIV/HBV co-infection was 6.02% (95% CI 2.4-9.7). There was no significant effect of HBV status on elevation of ALT levels with 12 months of HAART. Co-infected patients had an odds ratio of achieving immune response of 0.14 (95% CI 0.02-0.79). CONCLUSION HIV/HBV co-infection rates in our children are comparable to other localities. ALT levels do not worsen with HAART and immune response of the co-infected children on HAART is lower.
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Affiliation(s)
- E E Ikpeme
- Department of Paediatrics, University of Uyo Teaching Hospital -PMB 1136 Uyo Akwa Ibom State, Nigeria
| | - O M Etukudo
- Department of Paediatrics, University of Uyo Teaching Hospital -PMB 1136 Uyo Akwa Ibom State, Nigeria
| | - U E Ekrikpo
- Department of Internal Medicine University of Uyo Teaching Hospital, Uyo, Akwa Ibom State, Nigeria
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Healy SA, Gupta S, Melvin AJ. HIV/HBV coinfection in children and antiviral therapy. Expert Rev Anti Infect Ther 2013; 11:251-63. [PMID: 23458766 DOI: 10.1586/eri.13.2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Small cohort studies from countries where both HIV and HBV are endemic demonstrate prevalence rates of chronic hepatitis B in HIV-infected children of between 1 and 49%. While data on coinfected children are limited, results from studies in adults with HIV/HBV coinfection raise the concern that coinfected children may be at a higher risk of liver disease, hepatic fibrosis and cirrhosis. With the scale-up of combination antiretroviral therapy worldwide, of which lamivudine is included in most first-line regimens, coinfected children treated with lamivudine risk development of HBV resistance mutations. This article summarizes the current literature relevant to HIV/HBV coinfection in children, the options for treatment and highlights priorities for future research.
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Affiliation(s)
- Sara A Healy
- Seattle Biomedical Research Institute, Seattle, WA, USA
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19
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Dziuban EJ, Marton SA, Hughey AB, Mbingo TL, Draper HR, Schutze GE. Seroprevalence of hepatitis B in a cohort of HIV-infected children and adults in Swaziland. Int J STD AIDS 2013; 24:561-5. [DOI: 10.1177/0956462413476274] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Summary Hepatitis B virus (HBV) is an important co-morbidity in the HIV epidemic. A retrospective chart review was performed of HIV-infected patients with no previous antiretroviral history enrolled in a Swaziland clinic from January 2009 to May 2011. The seroprevalence of HBV surface antigen (HBsAg) was calculated and the data were analyzed using Mann-Whitney U and Fisher's exact tests. A total of 1282 patients were included in analysis. Five hundred were children aged <15 years. Overall HBsAg seroprevalence was 3.7% (1.4% of children and 5.1% of adults). Prevalence in under-5s was low (0.4%). Among adult women and men, prevalence was 4.2% and 9.8%, respectively ( P = 0.022). Median alanine aminotransferase level was 19 U/L in the HBsAg-negative adults and 25 U/L in the HBsAg-positive adults ( P = 0.005). Given the number of patients found to be HBsAg-positive, especially among adults, it is important for antiretroviral programmes to consider universal screening and strategically utilize medications that have been found effective in treating both HBV and HIV.
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Affiliation(s)
- E J Dziuban
- Baylor International Pediatric AIDS Initiative at Texas Children's Hospital, Houston, TX, USA
- Baylor College of Medicine Department of Pediatrics, Houston, TX, USA
- Baylor College of Medicine Bristol Myers Squibb Children's Clinical Center of Excellence-Swaziland, Mbabane, Swaziland
| | - S A Marton
- Baylor College of Medicine Department of Pediatrics, Houston, TX, USA
| | - A B Hughey
- Baylor International Pediatric AIDS Initiative at Texas Children's Hospital, Houston, TX, USA
| | - T L Mbingo
- Baylor College of Medicine Children's Foundation, Mbabane, Swaziland
| | - H R Draper
- Baylor International Pediatric AIDS Initiative at Texas Children's Hospital, Houston, TX, USA
- Baylor College of Medicine Department of Pediatrics, Houston, TX, USA
| | - G E Schutze
- Baylor International Pediatric AIDS Initiative at Texas Children's Hospital, Houston, TX, USA
- Baylor College of Medicine Department of Pediatrics, Houston, TX, USA
- Baylor College of Medicine Bristol Myers Squibb Children's Clinical Center of Excellence-Swaziland, Mbabane, Swaziland
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20
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Anigilaje EA, Olutola A. Prevalence and Clinical and Immunoviralogical Profile of Human Immunodeficiency Virus-Hepatitis B Coinfection among Children in an Antiretroviral Therapy Programme in Benue State, Nigeria. ISRN PEDIATRICS 2013; 2013:932697. [PMID: 23691352 PMCID: PMC3649331 DOI: 10.1155/2013/932697] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 03/17/2013] [Indexed: 12/14/2022]
Abstract
Background. Nigeria has the world largest burden of paediatric HIV and is also highly endemic for Hepatitis B virus (HBV). However, relatively little is known regarding the prevalence of HBV-HIV coinfections among Nigerian children. Methods. A retrospective study among treatment naive HIV-infected children attending the pediatric clinic of the APIN Plus/Harvard PEPFAR program of the Federal Medical Centre, Makurdi, between June 2008 and June 2012. Results. The mean age of the 395 subjects studied was 7.53 ± 4.23 years. Thirty-one subjects (7.8%) were positive for HBV. No subject was HIV-HBV-HCV triply infected. Significantly higher HIV-HBC coinfections were found, in older subjects (11-15 years), subjects that did not receive nor complete Hepatitis B vaccinations, and subjects that had a severe immunosuppression of < 15% with respective P values of 0.00, 0.01, and 0.00. HIV-HBV co-infection did not significantly impact on other baseline characteristics including, gender, WHO clinical stage, median absolute CD4 count, mean viral load, median ALT, and hepatotoxicity. Conclusion. A high seroprevalence of HBV among this cohort of HIV-infected children contributes to the calls for pre-ART screening for HBV and the necessary paradigm shift in the ART nucleoside backbone to include agent(s) more dually effective against HIV and HBV.
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Affiliation(s)
| | - Ayodotun Olutola
- Center for Clinical Care and Clinical Research, 29 Mambilla Street, Off Aso Drive, Maitama, Abuja, Nigeria
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Nwolisa E, Mbanefo F, Ezeogu J, Amadi P. Prevalence of hepatitis B co-infection amongst HIV infected children attending a care and treatment centre in Owerri, South-eastern Nigeria. Pan Afr Med J 2013; 14:89. [PMID: 23646225 PMCID: PMC3641926 DOI: 10.11604/pamj.2013.14.89.1711] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Accepted: 05/29/2012] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Hepatitis B infection impacts negatively on disease progression in HIV infected children thereby increasing morbidity and mortality. In spite of the foregoing, there is paucity of data on Hepatitis B co-infection in children living with HIV in Owerri, South Eastern Nigeria.This study set out to determine the prevalence of Hepatitis B Co- infection in HIV infected children attending the Paediatric HIV Care and Treatment clinic of the Federal Medical Centre Owerri. METHODS The study period was between February and July 2010. Testing for Hepatitis B infection was done using the ACON Hepatitis B surface antigen Rapid test strip. (Acon Laboratories Inc. San Diego.CA). RESULTS A total of 139 HIV infected children were enrolled during the study period. The overall prevalence of Hepatitis B Co- infection was 5.8% (8/139). The prevalence in males was 8.2% (5/61) while in females it was 3.8% (3/78). The prevalence of Hepatitis B Co- infection amongst patients on antiretroviral therapy was 4.6%. They accounted for 62.5% of Hepatitis B Co- infection in our study. Previous blood transfusion, gender and age of patient did not show statistically significant relationship with Hepatitis B Co-infection. CONCLUSION Though our study shows a low prevalence of Hepatitis B co infection in HIV infected children in our centre, reduction of the rate is still strongly desirable. Reduction can be achieved by strengthening the uptake of Hepatitis B vaccine as part of the routine childhood immunization programme.
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Affiliation(s)
- Emeka Nwolisa
- Paediatric Infectious diseases Unit, Department of Paediatrics, Federal Medical Centre, Owerri Imo State, Nigeria
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Aurpibul L, Lumbiganon P, Kolasaraksa P, Hansudewechakul R, Sa-nguanmoo P, Taeprasert P, Bunupuradah T, Pooworawan Y, Sirisanthana V, Puthanakit T. HIV and Hepatitis B coinfection among perinatally HIV-infected Thai adolescents. Pediatr Infect Dis J 2012; 31:943-7. [PMID: 22592516 PMCID: PMC3511890 DOI: 10.1097/inf.0b013e31825eb0ad] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVES This study aimed to determine the prevalence of hepatitis B virus (HBV) coinfection and HBV seropositivity in perinatally HIV-infected adolescents. A secondary objective was to describe the clinical characteristics of adolescents with chronic HBV/HIV coinfection. MATERIALS AND METHODS Multicenter cross-sectional study of perinatally HIV-infected adolescents aged 12-25 years. HBV surface antigen, surface antibody (anti-HBs) and core antibody (anti-HBc) were measured. Coinfection was defined as having persistently positive HBV surface antigen. Seroprotective antibody from immunization was defined as having anti-HBs ≥10 mIU/mL with negative anti-HBc. HBV DNA quantitation and rtM204V/I mutation analysis (lamivudine resistance-associated mutation) were performed in adolescents with chronic HBV infection. RESULTS From November 2010 to March 2011, 521 patients were enrolled. Mean (SD) of CD4 lymphocyte count was 685 (324) cells/μL. The prevalence of HBV/HIV coinfection was 3.3% (95% confidence interval: 1.9-5.2%). Protective antibody against HBV was found in 18% of population, and this was significantly higher among adolescents who received than those who did not receive HBV revaccination after receiving antiretroviral therapy (93% versus 6%, P < 0.01). Among adolescents with chronic HBV infection, 88% have received lamivudine; however, 69% have HBV DNA >10 copies/mL and 75% had the rtM204V/I mutation. CONCLUSIONS The prevalence of HBV coinfection in HIV-infected Thai adolescents was 3.3%. Most HIV-infected adolescents had no HBV protective antibody; therefore, revaccination with HBV vaccine is encouraged. The high prevalence of HBV-lamivudine resistance underscores the importance of HBV screening prior to antiretroviral therapy initiation to guide the selection of optimal regimen for coinfected children.
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Affiliation(s)
- Linda Aurpibul
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai
| | | | | | | | - Pattaratida Sa-nguanmoo
- The Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University
| | | | - Torsak Bunupuradah
- The Netherlands, Australia, Thailand Research Collaboration (HIVNAT), Bangkok
| | - Yong Pooworawan
- The Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University
| | - Virat Sirisanthana
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai
| | - Thanyawee Puthanakit
- The Netherlands, Australia, Thailand Research Collaboration (HIVNAT), Bangkok
- Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Zhang T, Shao X, Chen Y, Zhang T, Minhas V, Wood C, He N. Human herpesvirus 8 seroprevalence, China. Emerg Infect Dis 2012; 18:150-2. [PMID: 22257662 PMCID: PMC3310085 DOI: 10.3201/eid1801.102070] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
To summarize the seroprevalence of human herpesvirus 8 (HHV-8) in mainland China, we conducted a systematic review and meta-analysis based on available literature. Data show that differences in HHV-8 prevalence vary considerably among different ethnic groups and geographic regions. Blood-borne transmission could be a potential route for HHV-8 infection in China.
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Affiliation(s)
- Tiejun Zhang
- Fudan University, Shanghai, People’s Republic of China.
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24
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Sero-prevalence of viral co-infections in HIV infected children of Northern India. Indian J Pediatr 2009; 76:917-9. [PMID: 19475358 DOI: 10.1007/s12098-009-0142-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2008] [Accepted: 08/07/2008] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To assess the prevalence of viral co-infections in HIV infected children. METHODS Children born to HIV seropositive parents and those children who were suspected to be HIV infected based on clinical presentation by the pediatrician were screened for HIV -1 and 2 antibodies as per National Aids Control Organization (NACO) guidelines. Those found to be seropositive for HIV infection were further tested for Hepatitis B&C, Herpes simplex virus and Human cytomegalovirus infection. RESULTS Among 803 children screened, 101 were found positive for HIV antibodies. Among the five viral markers tested, HCMV IgG was positive in 88 children (87.1%). HCMV IgM was positive in 35 cases (34.6%). HBsAg tested positive in 30 children, while anti-HCV IgM was reactive in 27 cases. IgM anti- HSV antibodies were observed positive in 59 (58.4%) cases. Both hepatitis virus coinfection (HBsAg and anti- HCV IgM antibodies) was observed in 10 HIV positive children, while both Herpesviridae family viruses (HCMV -IgM antibodies and HSV -IgM antibodies) were positive in 30 cases (29.7%). CONCLUSION Viral co-infections are significantly higher in HIV positive children, which adds to significant mortality and morbidity and should therefore be screened in all HIV positive children for timely treatment in order to improve the quality of life and better survival of HIV infected children.
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Rouet F, Chaix ML, Inwoley A, Anaky MF, Fassinou P, Kpozehouen A, Rouzioux C, Blanche S, Msellati P. Frequent Occurrence of Chronic Hepatitis B Virus Infection among West African HIV Type-1--Infected Children. Clin Infect Dis 2008; 46:361-366. [DOI: 10.1086/525531] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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26
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Telatela SP, Matee MI, Munubhi EK. Seroprevalence of hepatitis B and C viral co-infections among children infected with human immunodeficiency virus attending the paediatric HIV care and treatment center at Muhimbili National Hospital in Dar-es-Salaam, Tanzania. BMC Public Health 2007; 7:338. [PMID: 18031586 PMCID: PMC2204008 DOI: 10.1186/1471-2458-7-338] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2007] [Accepted: 11/22/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With increased availability of antibiotics and antifungal agents hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are becoming a cause for significant concern in HIV infected children. We determined the seroprevalence and risk factors for HBV and HCV among HIV infected children aged 18 months to 17 years, attending the Paediatric HIV Care and Treatment Center (CTC) at Muhimbili National Hospital (MNH) in Dar-es-Salaam, Tanzania. METHODS Investigations included; interviews, physical examination and serology for HBsAg, IgG antibodies to HCV and alanine aminotransferase (ALT) levels. HIV serostatus and CD4 counts were obtained from patient records. RESULTS 167 HIV infected children, 88(52.7%) males and 79(47.3%) females were enrolled. The overall prevalence of hepatitis co-infection was 15%, with the seroprevalence of HBV and HCV being 1.2% and 13.8%, respectively. Hepatitis virus co-infection was not associated with any of the investigated risk factors and there was no association between HBV and HCV. Elevated ALT was associated with hepatitis viral co-infection but not with ART usage or immune status. CONCLUSION The high seroprevalence (15%) of hepatitis co-infection in HIV infected children attending the Paediatrics HIV CTC at the MNH calls for routine screening of hepatitis viral co-infection and modification in the management of HIV infected children.
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Affiliation(s)
- Safila P Telatela
- Department of Paediatrics and Child Health, Muhimbili University College of Health Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Mecky I Matee
- Department of Microbiology and Immunology, Muhimbili University College of Health Sciences, P.O. Box 65347, Dar es Salaam, Tanzania
| | - Emmanuel K Munubhi
- Department of Paediatrics and Child Health, Muhimbili University College of Health Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
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Kaul R, Pettengell C, Sheth PM, Sunderji S, Biringer A, MacDonald K, Walmsley S, Rebbapragada A. The genital tract immune milieu: an important determinant of HIV susceptibility and secondary transmission. J Reprod Immunol 2007; 77:32-40. [PMID: 17395270 DOI: 10.1016/j.jri.2007.02.002] [Citation(s) in RCA: 113] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2006] [Revised: 02/01/2007] [Accepted: 02/12/2007] [Indexed: 02/02/2023]
Abstract
HIV is generally sexually acquired across the genital or rectal mucosa after exposure to the genital secretions of an HIV-infected partner. Most exposures to HIV do not result in infection, likely due to protection afforded by an intact mucosal epithelium, as well as by innate and adaptive mucosal immune factors present in the genital tract. Another important mucosal determinant of transmission may be the number and activation status of potential HIV target cells, including CCR5/CD4+ T cells and DC-SIGN+ dendritic cells. The simultaneous presence of other genital infections, including classical sexually transmitted infections (STIs), can enhance HIV susceptibility either by breaching the epithelial barrier, recruiting HIV target cells to the genital tract, or by generating a pro-inflammatory local immune milieu. In HIV-infected individuals, genital co-infections increase HIV levels in the genital secretions, thereby increasing secondary sexual transmission. Co-infections that act as important HIV cofactors include human cytomegalovirus (CMV), Herpes simplex virus type 2 (HSV2), Neisseria gonorrhoeae and many others. Strategies focused on genital co-infections, such as vaccines, microbicides and suppressive therapy, are feasible in the short term and have the potential to curb the pandemic.
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Affiliation(s)
- R Kaul
- Clinical Science Division, Department of Medicine, University of Toronto, Canada.
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28
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Buka I, Koranteng S, Osornio Vargas AR. Trends in childhood cancer incidence: review of environmental linkages. Pediatr Clin North Am 2007; 54:177-203, x. [PMID: 17306690 DOI: 10.1016/j.pcl.2006.11.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Cancer in children is rare and accounts for about 1% of all malignancies. In the developed world, however, it is the commonest cause of disease-related deaths in childhood, carrying with it a great economic and emotional cost. Cancers are assumed to be multivariate, multifactorial diseases that occur when a complex and prolonged process involving genetic and environmental factors interact in a multistage sequence. This article explores the available evidence for this process, primarily from the environmental linkages perspective but including some evidence of the genetic factors.
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Affiliation(s)
- Irena Buka
- Paediatric Environmental Health Specialty Unit, Misericordia Hospital, 3 West, 16940 - 87 Avenue, Edmonton, AB T5R 4H5, Canada.
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29
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Schuval S, Lindsey JC, Stapleton JT, Van Dyke RB, Palumbo P, Mofenson LM, Oleske JM, Cervia J, Kovacs A, Dankner WN, Smith E, Nowak B, Ciupak G, Webb N, Eagle M, Smith D, Hennessey R, Goodman-Kerkau M, Klinzman D, Hess G, Zdunek D, Levin MJ. GB virus C infection in children with perinatal human immunodeficiency virus infection. Pediatr Infect Dis J 2005; 24:417-22. [PMID: 15876940 DOI: 10.1097/01.inf.0000160943.17750.94] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND GB virus C (GBV-C) infection occurs in 20-40% of human immunodeficiency virus (HIV)-infected adults, and coinfection is associated with improved HIV disease outcome. METHODS To determine the prevalence of GBV-C infection in children who were perinatally infected with HIV, we conducted a cross-sectional prevalence survey in a cohort of perinatally infected HIV-positive children selected from a large, multicenter observational protocol. A blood specimen was obtained and tested for GBV-C viremia with the use of a qualitative GBV-C RNA assay and screened for past GBV-C infection with enzyme-linked immunosorbent assay to detect antibodies to the GBV-C envelope protein E2 (E2 Ab). RESULTS The 354 children who participated in the substudy were relatively healthy, with a median CD4 of 784 cells/mm and median HIV-1 viral load of 1055 copies/mL. The prevalence of GBV-C viremia was 20 of 353 or 5.7% (95% confidence interval, 3.5-8.6%), and the prevalence of E2 Ab was 12 of 354 or 3.4% (95% confidence interval, 1.8-5.8%). GBV-C viremic patients were older than patients without past GBV-C infection (median age, 12.8 years versus 10.7 years). Median CD4 lymphocyte counts were highest in subjects without GBV-C infection and lowest in those with E2 Ab. CONCLUSIONS GBV-C prevalence rates are lower in children with perinatal HIV infection than those reported for HIV-infected adults. With the exception of evidence that GBV-C viremic children had lower rates of Centers for Disease Control and Prevention HIV disease category C disease before GBV-C testing, we did not find evidence of improved HIV disease outcome in coinfected patients, but the number of HIV/GBV-C-coinfected children was small.
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Affiliation(s)
- Susan Schuval
- Schneider Children's Hospital, Long Island Jewish Medical Center, New Hyde Park, NY 11042, USA.
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Abstract
The human immunodeficiency virus (HIV) pandemic has dramatically reversed improvements in infant mortality and child survival in sub-Saharan Africa. However, accurate information on the specific causes of HIV-related morbidity and mortality arising from vertical transmission is infrequent and is constrained in resource-poor settings by infrastructure and local access to health care. Such knowledge is essential to improve clinical management of HIV-infected children in Africa. In this review, a global overview of the clinical aspects of HIV infection in children is given. Factors influencing HIV disease progression, morbidity and mortality are discussed from studies on a cohort of HIV-infected children that were followed at an orphanage in Nairobi between 1999 and 2001. These parameters are contrasted with available data on HIV-infected children residing in community settings in Africa.
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Affiliation(s)
- Rana Chakraborty
- Paediatric Infectious Diseases Unit, 5th Floor Lanesborough Wing, St George's Hospital, Blackshaw Road, Tooting, London SW17 0QT, UK.
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Sathar MA, York DF, Gouws E, Coutsoudis A, Coovadia HM. GB virus type C coinfection in HIV-infected African mothers and their infants, KwaZulu Natal, South Africa. Clin Infect Dis 2004; 38:405-9. [PMID: 14727212 DOI: 10.1086/381092] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2003] [Accepted: 08/01/2003] [Indexed: 11/03/2022] Open
Abstract
GB virus type C (GBV-C) infection was studied in a convenience sample of 75 antiretroviral (ART)-naive African mothers with human immunodeficiency virus infection and their infants. GBV-C RNA was extracted from serum and amplified by reverse-transcriptase polymerase chain reaction. Twenty-seven (36%) of these 75 HIV-infected women tested positive for GBV-C RNA. To study transmission dynamics, we chose a random subsample of 20 of these women and their infants. In this cohort, there was evidence of postnatal transmission of GBV-C; however, it was not possible to demonstrate evidence of in utero or intrapartum transmission. In this pilot observational study, transmission of HIV from mother-to-infant occurs independently of the GBV-C infection status of the mother. The immunological indices measured tend to suggest an association with protection and or delayed progression of HIV disease in GBV-C-infected mothers.
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Affiliation(s)
- Mahomed A Sathar
- Department of Medicine, Nelson R. Mandela School of Medicine, Faculty of Health Sciences, University of Natal, Congella, Durban, South Africa.
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32
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Bollinger RC, Gupta A. GB virus type C: a virus in search of a disease or a role in HIV therapy? Clin Infect Dis 2004; 38:410-1. [PMID: 14727213 DOI: 10.1086/381102] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2003] [Accepted: 10/07/2003] [Indexed: 11/03/2022] Open
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