Prevalence and factors associated with hepatitis B in a cohort of HIV-infected children in the Pediatric Department at Donka National Hospital, Guinea

Introduction children pay a heavy price for infection with the hepatitis B virus (HBV). The objective of this work was to determine the prevalence of hepatitis B and describe the associated factors in children at the pediatric department of Donka Hospital. Methods this was a cross-sectional study of a cohort of children in the pediatric department of Donka Hospital. HBsAg was performed by using an immunochromatographic method. The analysis of the data was done with software R. The proportions were compared using the Chi-square test or the Fisher test at the significance level of 5%. A logistic regression model was used to explain the prevalence of hepatitis B. Results one hundred and forty-nine children were recruited between February and July 2017. HBsAg was present in 12 children, i.e. 8.16% (95% CI: 4.29-13.82). The average age was 93.32 months (IQR: 6-180). Male children were the most affected (n = 11, P <0.05), with a sex ratio of 1.01. The majority (51.35%) were on AZT + 3TC + NVP pediatric form and 25% were on AZT + 3TC + NVP adult form and 23.65% on TDF + FTC + EFV. In univariate analysis, ALT, HBsAg positivity, and maternal HBV vaccination status were associated with the prevalence of HBsAg (P <0.05). Conclusion the prevalence of co-infection in children and adults is almost identical in our context. Hence the importance of strengthening preventive measures at all levels, especially the vaccination of children and mothers.


Hepatitis B virus (HBV) infection and human immunodeficiency virus (HIV) infection are considered by the World Health Organization
(WHO) as major public health problems. HBV infection is the leading cause of acute and chronic liver disease in the world, such as cirrhosis or hepatocellular carcinoma, which is responsible for the majority of liver cancers worldwide [1]. The prevalence of HBV infection in children is 1.3 worldwide; 80 to 90% of infected infants in the first year of life will have a chronic infection and 30 to 50% of children infected before the age of 6 will be chronically infected [2]. HBV shares with HIV certain pathways of contamination, favoring the possibility of co-infection. For example, the prevalence of HIV/HBV coinfection is high in some "at risk" populations, such as intravenous drug users, polytransfused individuals, and so on. Vertical transmission is the major pathway of HBV and HIV infection in children [3] According to new data in 2017, WHO reports that 325 million people are living with chronic hepatitis B infection [4], of which 1.2 to 4.9% of children are carriers of HIV. HBsAg and infected with HIV [5,6]. Sub-Saharan Africa is a region with a high prevalence of hepatitis B infection where the prevalence of HIV co-infection and hepatitis B varies between 10% and 20% in West and Central Africa [7,8]. The prevalence of HIV/HBV in children in KwaZulu-Natal (South Africa) was 13.0% [9], in Nigeria, it was 8.3% [10]. In Guinea, prevalence studies conducted on HIV-HBV coinfection concern the adult population and are estimated at 8.49% [7]. The purpose of this study was to determine the prevalence of hepatitis B and describe the associated factors in HIV-infected children who were followed in the pediatric department at Donka National Hospital.

Methods
This was a 6-month cross-sectional study from 1 st February to 31 st July 2017 in the pediatric department of Donka National Hospital.
Laboratory analyzes were performed at the Nestor Bangoura/Hélène Labrousse Molecular Biology Laboratory of the Ambulatory Treatment Center (ATC) at Donka National Hospital.
Study population: we included all children aged 0 to 15 regardless of gender and followed for HIV infection, of which at least one of the parents or guardians gave informed consent and agreed to conduct the HBsAg research for the child. All mothers whose children participated in the study were included after obtaining their informed consent regardless of age or even HIV status.
Data collection: we recorded the medical records of HIV-infected children on ART followed in the Donka pediatric department during our study period. A questionnaire was used to collect sociodemographic data, family history of hepatitis, previous vaccination against hepatitis B, concept of blood exposure, clinical and paraclinical data. HBsAg was investigated in the serum of the participants using the AgHBs Kits ® rapid test from Gemc Technology Group Limited. All participants in the study were referred to the laboratory for venous sampling on dry tubes. All samples were centrifuged to obtain serum for analysis.  Of the mothers, 8.05% were carriers of HBsAg. Of the 142 women who gave birth vaginally, 10 were carriers of HBsAg versus 2 of those delivered by caesarean section, and all 10 would have transmitted HBV to their newborn. Among the factors studied in univariate analysis, the sex of the child (p = 0.003), the maternal vaccination status (p = 0.000), the positivity of the HBsAg in the mother (p = 0.000), the rate of LTCD4 + (p = 0.03) and ALT (p = 0.000) were associated with carriage of HBsAg in children ( Table 2). In multivariate analysis, only ALAT was associated with the carriage of HBsAg (Table 3).

Discussion
We performed a cross-sectional study in a cohort of children followed

Conclusion
The prevalence of HIV-HBV co-infection in children followed in the pediatric department was 8.16%, which is not very different from the numbers in adults. It was higher in boys than in girls, in subjects with LTCD4+ <500 cells/mm 3 and in those with abnormal ALAT levels.

What is known about this topic
• HBV infection is the leading cause of acute and chronic liver disease in the world; • Eighty to 90% of infected infants in the first year of life will be chronically infected and 30% to 50% of infants infected before the age of 6 will be chronically infected; • Vertical transmission is the major route of infection of HBV and HIV in children.

What this study adds
• A prevalence of HBV-HIV coinfection in children estimated at 8.16% (95% CI: 4.29-13.82); • A vaccination rate for mothers at 62.4% and therefore there is effort to provide; • A focus on vertical transmission. All infected children are born to HIV-positive mothers for HBsAg.
(PLHIV) organizations and the patients who were kind enough to participate to this study. Table 1: characteristic of the study population Table 2: factors associated with HIV-HBV coinfection