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

.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.

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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: 593-601. [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]
7. 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]
8. 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]
9. 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]
10. 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]
11. 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]
12. 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.
13. Matthews GV, Avihingsanon A, Lewin SR, Amin J, Rerknimitr R, Petcharapirat P, et al. A randomized trial of combination hepatitis B therapy in HIV/HBV coinfected antiretroviral naive individuals in Thailand. Hepatology 2008;48:1062-9. [CrossRef]
14. Ingiliz P, Valantin MA, Thibault V, Duvivier C, Dominguez S, Katlama C, et al. Efficacy and safety of adefovir dipivoxil plus pegylated interferon-alpha2a for the treatment of lamivudine-resistant hepatitis B virus infection in HIV-infected patients. Antivir Ther 2008;13:895-900.
15. Matthews GV, Manzini P, Hu Z, Khabo P, Maja P, Matchaba G, et al. Impact of lamivudine on HIV and hepatitis B virus-related outcomes in HIV/hepatitis B virus individuals in a randomized clinical trial of antiretroviral therapy in southern Africa. AIDS 2011;25:1727-35. [CrossRef]
16. 1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. MMWR Recomm Rep 1992;41:1-19.
17. Ministerul Sanatatii Publice. Ghidul TARV Romania 2011-2012. Available online: http://www.cnlas.ro/images/doc/ghidtarv.pdf.
18. Ofotokun I, Smithson SE, Lu C, Easley KA, Lennox JL. Liver enzymes elevation and immune reconstitution among treatmentnaïve HIV-infected patients instituting antiretroviral therapy. Am J Med Sci 2007;334:334-41.[CrossRef]