Background:  Little data are available on prevalence rates for hepatitis B (HBV) or hepatitis C virus (HCV) co-infection among HIV-infected children in resource-limited settings. Studies show that HIV infection leads to a more aggressive course of HBV or HCV infection and a higher risk of liver damage. Co-infection may also complicate antiretroviral treatment (ART), with higher rates of ART-induced hepatotoxicity among patients with chronic hepatitis. This study aims to evaluate rates of HBV and HCV co-infection among a cohort of HIV-infected Nigerian children in a large antiretroviral treatment program. Such information has the potential to impact decisions regarding ART in co-infected children.  

Methods:  The APIN Plus/Harvard PEPFAR Program has provided HIV care to over 85,000 people, including 4366 children in Nigeria since 2004. At enrollment, all pediatric patients undergo screening for HBV and HCV in addition to evaluation of HIV disease markers. Baseline patient characteristics including median age at enrollment, CD4⁺ cell count, WHO clinical stage, and transaminase level were compared between hepatitis co-infected and HIV mono-infected patients. 

Results:  Prevalence of HBV and HCV was 8.3% (54 of 648) and 2.7% (17 of 637) among HIV^‑ co-infected children, respectively. Only one child was identified with both HBV and HCV infection. Baseline characteristics including median age (3.6 years for HBV⁺, 3.0 yrs HCV⁺, 3.5 years for HIV mono-infected), CD4 cell count, and WHO clinical stage were not significantly different between HBV or HCV co-infected, and HIV-mono-infected children. Significant ALT elevation to >5 times the ULN was present in a small proportion of patients overall (6.5%) and was not significantly different between hepatitis co-infected and HIV mono-infected children. More HCV co-infected patients were male (76%) than HIV mono-infected children (54%), but this difference did not reach statistical significance (P =0.083).  

Conclusions:  This is the first cohort study to assess the prevalence of hepatitis co-infection in a cohort of HIV-infected pediatric patients in Nigeria. Overall, HBV or HCV infection was identified in 11.5% of children for whom both test results were available. Further evaluation of outcomes will provide insight as to the impact of HBV or HCV co-infection on pediatric HIV treatment outcomes. Such information should encourage research into expanding treatment options for children with hepatitis and HIV co-infection.