Characteristics of Hepatitis B Co-infection and Disease Evolution in HIV-Positive Paediatric Patients in Romania

Abstract

Background: Infection with hepatitis B virus (HBV) contributes to morbidity and mortality in people living with human immunodeficiency virus (HIV). Aims: The aim of the present study is to assess the influence of HBV co-infection in clinical characteristics and disease evolution among nosocomial HIV infected youth in Romania. Study Design: Retrospective study. Methods: We assessed HBsAg in 179 young people with nosocomial paediatric HIV infection. Demographic data, ALAT level, CD4-count, HIV-RNA, antiretroviral therapy and clinical behaviour were all statistically compared in patients who were HIV mono-infected and HBV-co-infected. Results: The characteristics of patients are as follows: sex ratio M/F: 55.3%, AIDS category 88%, median nadir CD4-count 126/mm3. The prevalence of persistent HBsAg was 44.6%. The mortality rate was 11.1%, but no correlation with HBsAg was found. An average of three antiretroviral combinations is experienced by 97.7% of patients, including Lamivudine for over 5 years in 76% of cases and Tenofovir/Emtricitabine in 16.75% of patients. Patients under antiretroviral therapy achieved 53.07% sustained undetectable HIV-RNA and 40.78% restored immunity CD4-count >500/mm3. ALAT enzyme was found to be high in 54.75% of patients. Conclusion: During our research, we noticed that HBsAg was elevated in young people with HIV in Romania. Mortality rate was not statistically correlated to HBsAg. High ALAT levels are related with HBV, HDV co-infections, virological failure to antiretroviral treatment and the risk of death. Turkish Başlık: Romanya Gençliğinde HIV-Hepatit B Ko-enfeksiyonunun Özellikleri Anahtar Kelimeler: HIV, Hepatit B, antiviral ajanlar, Romanya Arkaplan: Hepatit B virüsü (HBV) ile enfeksiyon insan immün yetmezlik virüsü (HIV) ile yaşayan kişilerde morbidite ve mortaliteye katkıda bulunmaktadır. Amaç: Bu çalışmanın amacı, Romanya'da nozokomiyal HIV enfekte gençler arasında klinik özellikler ve hastalığın evriminde HBV ko-enfeksiyonunun etkisini değerlendirmektir. Çalışma Tasarımı: Retrospektif çalışma. Yöntemler: Nozokomiyal pediatrik HIV enfeksiyonu olan 179 genç kişide HBsAg'yi değerlendirdik. Demografik veriler, ALAT düzeyi, CD4-sayısı, HIV-RNA, antiretroviral tedavi ve klinik davranış istatistiksel olarak HIV mono-enfekte ve HBV-ko-enfekte olan hastalarda karşılaştırıldı. Bulgular: Hastaların özellikleri aşağıdaki gibidir: cinsiyet oranı E/K: %55.3, AIDS kategori %88, medyan en düşük CD4-sayısı 126/mm3. Kalıcı HBsAg prevalansı % 44.6 idi. Mortalite hızı %11.1 idi, ancak HBsAg ile bir korelasyonu bulunmadı. Olguların %76'sında 5 yıldır Lamivudin ve hastaların %16.75'inde Tenofovir/Emtrisitabin dahil olmak üzere hastaların %97.7'sinde ortalama üç antiretroviral kombinasyonu kullanıldı. Antiretroviral tedavi altındaki hastalarda %53.07 süreklilik gösteren saptanamayan HIV-RNA ve %40.78 yeniden sağlanan immünite CD4–sayısı >500/mm3 düzeyine ulaşıldı. ALAT enzimi hastaların% 54.75'inde yüksek olarak bulundu. Sonuç: Araştırmamız sırasında, HBsAg'nin Romanya'da HIV'li gençlerde yüksek olduğunu fark ettik. Mortalite hızı istatistiksel olarak HBsAg ile korele değildi. Yüksek ALAT seviyeleri HBV, HDV ko-enfeksiyonu, antiretroviral tedaviye virolojik başarısızlık ve ölüm riski ile ilişkili idi.

Keywords

• HIV, Hepatitis B, antiviral agents, Romania

Characteristics of Hepatitis B Co-infection and Disease Evolution in HIV-Positive Paediatric Patients in Romania

Öz

References

1. Wang HS, Han SH. Management of hepatitis B in special population. Clinical Liver Disease 2010;14:505-20. [CrossRef]
2. Konopnicki D, Mocroft A, de Wit S, Antunes F, Ledergerber B, Katlama C, et al. Hepatitis B and HIV: prevalence, AIDS progression, response to highly active antiretroviral therapy and increased mortality in the EuroSIDA cohort. AIDS 2005;19: 593-60 [CrossRef]
3. Liaw YF, Brunetto MR, Hadziyannis S. The natural history of chronic HBV infection and geographical differences. Antiviral Therapy 2010;15:25-33. [CrossRef]
4. Tekin Koruk S, Koruk I, Gursoy B, Çalisir C, Kuksell F, Yildiz Zeyrek F, et al. Hepatitis B and Hepatitis C Seroprevalence in the Center of Sanliurfa Province From Southeastern Anatolia Region and Related Risk Factors. Balkan Med J 2010;27:367-72.
5. Pitigoi D, Rafila A, Pistol A, Arama V, Molagic V, Streinu-Cercel A. Trends in hepatitis B incidence in Romania, 1989-2005. Euro Surveill 2008;13:pii=8012.
6. Apetrei C, Loussert-Ajaka I, Collin G, Letourneur F, Duca M, Saragosti S, et al. HIV type 1 subtype F sequences in Romanian children and adults. AIDS Res Hum Retroviruses 1997;13:363-5. [CrossRef] Ruta SM, Matusa RF, Sultana C, Manolescu L, Kozinetz CA, Kline MW, et al. High prevalence of hepatitis B virus markers in romanian adolescents with human immunodeficiency virus infection. J Int AIDS Soc 2005;7:68. [CrossRef]
7. Audsley J, du Cros P, Goodman Z, McLean C, Mijch A, Lewin SR, et al. HIV replication is associated with increased severity of liver biopsy changes in HIV-HBV and HIV-HCV co-infection. J Med Virol 2012;84:993-1001. [CrossRef]
8. Soriano V, Grint D, d’Arminio Monforte A, Horban A, Leen C, Poveda E, et al. Hepatitis delta in HIV-infected individuals in Europe. AIDS 2011;25:1987-92. [CrossRef]

9. Dore GJ, Soriano V, Rockstroh J, Kupfer B, Tedaldi E, Peters L, et al. Frequent hepatitis B virus rebound among HIV-hepatitis B virus-coinfected patients following antiretroviral therapy interruption. AIDS 2010;24:857-65. [CrossRef]
10. Nikolopoulos GK, Paraskevis D, Hatzitheodorou E, Moschidis Z, Sypsa V, Zavitsanos X, et al. Impact of Hepatitis B Virus Infection on the Progression of AIDS and Mortality in HIV-Infected Individuals: A Cohort Study and Meta-Analysis. Clin Infect Dis 2009;48:1763-71. [CrossRef]
11. European AIDS Clinical Society Guidelines for treatment of HIV infected adults in Europe, 2011. Version 6.0. Available online: http://www.europeanaidsclinicalsociety.org/images/stories/ EACS-Pdf/EACSGuidelines-v6.0-English.pdf.
12. Matthews GV, Avihingsanon A, Lewin SR, Amin J, Rerknimitr R, Petcharapirat P, et al. A randomized trial of combination hepatitis