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Seroprevalence of HBV and HCV among Children in the Kilimanjaro Region, Tanzania

Kilimanjaro Christian Medical Centre Moshi, Tanzania. Seroprevalence of HBV and HCV among Children in the Kilimanjaro Region, Tanzania. Florida J. Muro , Suzanne P. Fiorillo , Christopher Odhiambo , Coleen K. Cunningham, Ann M. Buchanan KCMC-Duke Collaboration Moshi Tanzania

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Seroprevalence of HBV and HCV among Children in the Kilimanjaro Region, Tanzania

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  1. Kilimanjaro Christian Medical Centre • Moshi, Tanzania Seroprevalence of HBV and HCV among Children in the Kilimanjaro Region, Tanzania Florida J. Muro, Suzanne P. Fiorillo, Christopher Odhiambo, Coleen K. Cunningham, Ann M. Buchanan KCMC-Duke Collaboration Moshi Tanzania XIX International AIDS Conference, Washington, DC 24 July 2012

  2. Background • More than 350 million people worldwide are infected with hepatitis B virus (HBV), 170 million with hepatitis C virus (HCV) • HBV and HCV are more prevalent among HIV-infected individuals • HIV increases the speed of liver dysfunction among those with co-infection • Liver disease due to chronic hepatitis: increasing cause of morbidity and mortality among those with HIV

  3. Background • Chronic HBV infection risk: • up to a 90% risk with perinatal infection • 25-30% risk with early childhood infection • < 5% risk among adults • HCV infection: chronic infection in 75-80% of adults • Data on hepatitis-HIV co-infection among African populations are scarce

  4. Background • Three phases of chronic HBV infection: Children are typically in the immune tolerant phase.

  5. Objective • To determine Hepatitis B and Hepatitis C prevalence in healthy HIV-negative and HIV-infected children in Kilimanjaro Region, Tanzania

  6. Methods • Banked serum/plasma samples • HIV-uninfected, healthy children: 1 month -18 years • N=385 • HIV-infected children on HAART, 1-16 years • N=158 • HBV testing: • Hepatitis B surface ag (HBsAg) • Hepatitis B core antibody (HBcAb) • Hepatitis B surface antibody (HBsAb) • Study Location: Moshi, Kilimanjaro Region, • Tanzania, East Africa

  7. Methods • HCV testing: • Anti-HCV ELISA • Validation studies performed on all assays prior to use • All assays FDA-approved • Definitions: • Any prior HBV infection: HBcAb or HBsAg + • Presumptive chronic HBV infection: HBsAg + at time of test

  8. Results • 543 serum/plasma samples tested • 385 HIV-negative • 158 HIV-infected • Evidence of any HBV infection: 4.2% (95% CI: 2.5, 5.9) • Among HIV-negative children: 2.1% (95% CI: 0.6, 3.5) • Among HIV-infected children: 9.5% (95% CI 4.9, 14.1)

  9. Results Children with HIV infection were more likely to have evidence of HBV infection than HIV-negative children: OR 4.9 (95% CI 2.1, 11.9) p < 0.0001

  10. Results • *These 2 patients were HBcAb and HBsAb positive, likely reflecting maternal antibody transmission

  11. Results • Prevalence of presumed chronic HBV infection: 3.0% (1.6, 4.5) • Among HIV-negative children: 1.3% (0.2, 2.5) • Among HIV-infected children: 7.5% (3.2, 11.9) • Resolved infection (HBcAb and HBsAb positive) was found in 5 patients: 2 HIV-infected and 3 HIV-negative • Isolated HBcAb was found in two patients • Hepatitis C: 541 samples tested by anti-HCV ELISA • 0.0%

  12. Results

  13. Results N=44

  14. Conclusions • HCV was not found in this large pediatric cohort • HBV prevalence is high among HIV-infected children in the Kilimanjaro Region of Tanzania • Children with HIV are almost 5 times as likely to show evidence of infection than children without HIV

  15. Conclusions • The prevalence of chronic HBV-HIV co-infection in this population (7.5%) is higher than that reported recently in many other pediatric populations: • 3.3% Thailand • 4.9% China • 4% Kenya • 1.2% Dar es Salaam, Tanzania • Though lower than some other African countries: • Nigeria (7.7%) • Namibia (8.7%) • Ivory Coast (12.1%)

  16. Conclusions • High prevalence of HIV-HBV co-infection in this pediatric population • Need for routine HBsAg screening of all HIV-infected children • Prior to HAART initiation • More comprehensive prevalence data needed – across all age groups • Prevention of HBV could be strengthened by wider vaccination coverage • Vaccinate high risk children • Birth dose?

  17. Limitations • Chronic hepatitis B could not be confirmed • Samples tested at a single timepoint • Larger sample size needed to determine true prevalence of HIV-HBV co-infection among children in this region • The significance of isolated HBcAb in two patients is unclear • No measurement of HBV DNA

  18. Further Study • Follow up study planned for a larger prospective study of HIV-infected children • Unanswered questions: • Best treatment options for HIV-HBV infected children? • Already on HAART? • Immune tolerant disease • Immune active disease • Initiating HAART? • Immune tolerant disease • Immune active disease

  19. Acknowledgements • Co-authors: Florida Muro, Chris Odhiambo, Suzanne Fiorillo, Coleen Cunningham • Duke University Center for AIDS Research (CFAR) • 2010 developmental grant (5P30 AI064518) (AM Buchanan) • Duke Global Health Institute • Transition Award (FJ Muro) • Kilimanjaro Christian Medical Centre Leadership • Patients and families in the Kilimanjaro Region

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