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HIV and Hepatitis B Coinfection Among Perinatally HIV-infected Thai Adolescents

Aurpibul, Linda MD*; Lumbiganon, Pagakrong MD; Kosalaraksa, Pope MD; Hansudewechakul, Rawiwan MD; Sa-nguanmoo, Pattaratida PhD§; Taeprasert, Pawinee MD; Bunupuradah, Torsak MD; Poovorawan, Yong MD§; Sirisanthana, Virat MD*; Puthanakit, Thanyawee MD¶║

The Pediatric Infectious Disease Journal: September 2012 - Volume 31 - Issue 9 - p 943–947
doi: 10.1097/INF.0b013e31825eb0ad
HIV Reports

Objectives: This study aimed to determine the prevalence of hepatitis B virus (HBV) coinfection and HBV seropositivity in perinatally HIV-infected adolescents. A secondary objective was to describe the clinical characteristics of adolescents with chronic HBV/HIV coinfection.

Materials and Methods: Multicenter cross-sectional study of perinatally HIV-infected adolescents aged 12–25 years. HBV surface antigen, surface antibody (anti-HBs) and core antibody (anti-HBc) were measured. Coinfection was defined as having persistently positive HBV surface antigen. Seroprotective antibody from immunization was defined as having anti-HBs ≥10 mIU/mL with negative anti-HBc. HBV DNA quantitation and rtM204V/I mutation analysis (lamivudine resistance–associated mutation) were performed in adolescents with chronic HBV infection.

Results: From November 2010 to March 2011, 521 patients were enrolled. Mean (SD) of CD4 lymphocyte count was 685 (324) cells/μL. The prevalence of HBV/HIV coinfection was 3.3% (95% confidence interval: 1.9–5.2%). Protective antibody against HBV was found in 18% of population, and this was significantly higher among adolescents who received than those who did not receive HBV revaccination after receiving antiretroviral therapy (93% versus 6%, P < 0.01). Among adolescents with chronic HBV infection, 88% have received lamivudine; however, 69% have HBV DNA >105 copies/mL and 75% had the rtM204V/I mutation.

Conclusions: The prevalence of HBV coinfection in HIV-infected Thai adolescents was 3.3%. Most HIV-infected adolescents had no HBV protective antibody; therefore, revaccination with HBV vaccine is encouraged. The high prevalence of HBV-lamivudine resistance underscores the importance of HBV screening prior to antiretroviral therapy initiation to guide the selection of optimal regimen for coinfected children.

From the *Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand; Srinagarind Hospital, Khon Kaen University, Khon Kaen, Thailand; Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand; §The Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; The Netherlands, Australia, Thailand Research Collaboration (HIVNAT), Bangkok, Thailand; and Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.

Accepted for publication May 9, 2012

Supported by grant from TREAT Asia Supplemental Funding, the TREAT Asia Pediatric HIV Observational Database is an initiative of TREAT Asia, a program of amfAR, The Foundation for AIDS Research, with support from the US National Institutes of Health’s National Institute of Allergy and Infectious Diseases, Eunice Kennedy Shriver National Institute of Child Health and Human Development, and National Cancer Institute as part of the International Epidemiologic Databases to Evaluate AIDS (IeDEA; U01AI069907), and the Austrian AIDS Life Association; The National Research University Project of Commission of Higher Education and the Ratchadapiseksomphot Endowment Fund (HR 1161A-55) (T.P., Y.P.); Integrated Research to Expand the Capacity for Diagnosis, Management, and Prevention of AIDS/HIV, Sexual transmitted diseases (STI) and AIDS related Opportunistic Infections: A Model development for Resource Limited Countries (L.A.). The authors have no other funding or conflict of interest to disclose.

Address for Correspondence: Thanyawee Puthanakit, MD, Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.