Department of Pediatrics, Kigali University Teaching Hospital, Kigali, Rwanda.
Pediatr Infect Dis J. 2013 Mar;32(3):246-51. doi: 10.1097/INF.0b013e318271b93d.
The aim of this study was to determine the prevalence of hepatitis B virus (HBV) infection in a cohort of HIV-infected Rwandan children and adolescents on combination antiretroviral therapy (cART), and the success rate of HBV vaccination in those children found to be HBV negative.
HIV-infected children and adolescents (age 8-17 years) receiving cART with CD4 T-cells count ≥200 cells/mm and/or ≥15% and without prior HBV vaccination (by history, vaccination cards and clinic records) underwent serologic testing for past (negative HBV surface antigen [HBsAg] with positive antibody to HBV core antigen [cAb] and to HBsAg [anti-HBs]) or active HBV infection (positive HBsAg). Children with any positive HBV serologic tests were excluded from further vaccination; all others completed 3 HBV immunizations with 10 µg of ENGERIX-B. Anti-HBs titer was measured 4-6 weeks after the last immunization.
Of 88 children, 6 (7%) children had active HBV infection and 8 (9%) had past HBV infection. The median (interquartile range) age, CD4 T-cell count and cART duration were 12.3 (10.1-13.9) years, 626 (503 to 942) cells/mm and 1.9 (1.5-2.7) years, respectively. Seventeen children had detectable plasma HIV-1 RNA. Seventy-3 children completed 3 immunizations with median (interquartile range) postimmunization anti-HBs concentration of 151 mIU/mL (1.03-650). Overall, 52 children (71%, 95% confidence interval: 61-82) developed a protective anti-HBs response. HIV-1 RNA and CD4 T-cell count were independent predictors of a protective anti-HBs response. Protective anti-HBs response was achieved in 82% of children with undetectable HIV-1 RNA and 77% with CD4 T cells ≥350/mm.
The substantial HBV prevalence in this cohort suggests that HIV-infected Rwandan children should be screened for HBV before cART initiation. HIV viral suppression and CD4 T cells ≥350/mm favored the likelihood of a protective response after HBV vaccination.
本研究旨在确定在接受联合抗逆转录病毒疗法（cART）的卢旺达感染艾滋病毒的儿童和青少年队列中乙型肝炎病毒（HBV）感染的流行率，以及在发现 HBV 阴性的儿童中 HBV 疫苗接种的成功率。
接受 cART 的感染艾滋病毒的儿童和青少年（8-17 岁），CD4 T 细胞计数≥200 个细胞/mm³且/或≥15%，且无 HBV 疫苗接种史（根据病史、疫苗接种卡和临床记录），进行血清学检测以确定过去（HBV 表面抗原[HBsAg]阴性，乙型肝炎核心抗原[cAb]和 HBsAg[抗-HBs]抗体阳性）或活动性 HBV 感染（HBsAg 阳性）。任何 HBV 血清学检测阳性的儿童均被排除在进一步接种疫苗之外；所有其他儿童均接受了 3 次 10 µg 的 ENGERIX-B 乙肝免疫接种。最后一次免疫接种后 4-6 周测量抗-HBs 滴度。
在 88 名儿童中，有 6 名（7%）儿童患有活动性 HBV 感染，8 名（9%）儿童患有过去 HBV 感染。中位（四分位间距）年龄、CD4 T 细胞计数和 cART 持续时间分别为 12.3（10.1-13.9）岁、626（503 至 942）个细胞/mm³和 1.9（1.5-2.7）年。17 名儿童可检测到血浆 HIV-1 RNA。73 名儿童完成了 3 次免疫接种，中位（四分位间距）接种后抗-HBs 浓度为 151 mIU/mL（1.03-650）。总体而言，52 名儿童（71%，95%置信区间：61-82%）产生了保护性抗-HBs 反应。HIV-1 RNA 和 CD4 T 细胞计数是保护性抗-HBs 反应的独立预测因素。在 HIV-1 RNA 不可检测的儿童中，82%达到了保护性抗-HBs 反应，而 CD4 T 细胞≥350/mm³的儿童中，77%达到了保护性抗-HBs 反应。
本队列中 HBV 的高患病率表明，在开始 cART 之前，应筛查卢旺达感染艾滋病毒的儿童和青少年是否存在 HBV。HIV 病毒抑制和 CD4 T 细胞计数≥350/mm³有利于 HBV 疫苗接种后产生保护性反应。
