Prevalence and risk factors of hepatitis b infection in HIV infected children seen at national hospital Abuja

Background: Human immunodeficiency virus infection remains a global pandemic. Co infection with hepatitis B virus leads to rapid progression to AIDS if not diagnosed and promptly treated or better still prevented. The study aims at determining the prevalence and risk factors of hepatitis B infection in HIV infected children being followed up at the Paediatric HIV clinic. Patients and methods: A cross-sectional study of 261 HIV infected children aged eight months to fourteen years to determine the prevalence of Hepatitis B infection and pattern of hepatitis B vaccination was carried out between July and October 2012 at the Paediatric HIV clinic of National Hospital Abuja. Ethical approval was obtained from Ethical Committee of the hospital. Vaccination and transfusion history were obtained from the parents and guardians of the subjects using a proforma after signed informed consent. Blood samples were collected for Hepatitis B surface antigen screening and Hepatitis B screening in those with HBsAg positive blood samples. Results: Only 3 (1.15%) of the 261 HIV infected children had Hepatitis B infection. All the children less than 5 years old in this cohort received hepatitis B vaccination and none of them had Hepatitis B infection. The HIV/HBV co infected children were older than ten years (p = 0.047) and history of blood transfusion (p = 0.003) was also significant. However, scarification (p = 0.996), local circumcision (p = 0.928); uvulectomy (p = 0.898) were not significant risk factors in this cohort. Conclusion: There is need to intensify routine hepatitis B vaccination and routine screening of blood before necessary transfusion. This would further lead to a low prevalence of Hepatitis B in HIV infected children and the general populace at large.

Looking back at paediatric HIV treatment in South Africa. My, how we have grown!

Antiretroviral treatment has undergone major changes in the last 20 years, from monotherapy, to dual therapy and finally to triple therapy. Lately, more focus has been placed on better, more well-tolerated combinations and formulations. As in most other disciplines in medicine, the development of paediatric HIV dosages and formulations always tends to lag behind adult research. Twenty years ago, it could take several years before data were available to enable the use of life-saving antiretrovirals in children. Paediatricians, being ever resourceful, were not prepared to let their paediatric patients suffer despite the lack of data or formulations and so made a plan. This article describes some of the trials and tribulations that we went through trying to make sure that our paediatric HIV patients not only survived but thrived. Clinicians treating paediatric patients today have it so much easier because of what our colleagues and their patients went through in those early days.

Care Burden and Coping Strategies among Caregivers of Paediatric HIV/AIDS in Northern Uganda: A Cross-Sectional Mixed-Method Study

Background. Family caregivers provide the bulk of care to children living with HIV. This places an enormous demand and care burden on the caregivers who often struggle to cope in various ways, some of which may be maladaptive. This may adversely affect their quality of care. Very little literature exists in resource-limited contexts on the burden of care experienced by caregivers on whom children living with HIV/AIDS depend for their long-term care. We assessed care burden and coping strategies among the caregivers of paediatric HIV/AIDS patients in Lira district, northern Uganda. Methods. A mixed-method cross-sectional study was conducted among 113 caregivers of paediatric HIV patients attending the ART clinic at a tertiary healthcare facility in Lira district, northern Uganda. A consecutive sampling method was used to select participants for the quantitative study, while 15 respondents were purposively sampled for the qualitative data. Quantitative data were collected using standard interviewer-administered questionnaires, while in-depth interview guides were used to collect qualitative data. Data were entered, cleaned, and analysed using SPSS version 23. Qualitative data were analysed thematically. Results. The majority of the caregivers, 65.5% (74), experienced mild-to-moderate burden. The mean burden scores significantly differed by caregivers’ age ( P = 0.017 ), marital status ( P = 0.017 ), average monthly income ( P = 0.035 ), and child’s school attendance ( P = 0.039 ). Accepting social support, seeking spiritual support, and reframing were the three most commonly used strategies for coping. Marital status and occupation were, respectively, positively and negatively correlated with information-seeking as a coping strategy, while monthly income was positively correlated with psychosocial support as a strategy. Seeking community support was negatively correlated with the duration of the child’s care. Conclusions. Our findings show that care burden is a common problem among the caregivers of children living with HIV in the study context.

Estimating the burden of Paediatric HIV in an ‘A’ category district in India: An epidemiological study

Background: Epidemiological information on the disease burden of paediatric HIV is lacking in India. The National AIDS Control Program (NACP) provides estimates of paediatric HIV based on its projections of adult infections. The window of opportunity for diagnosis and treatment is very narrow a third of HIV infected children do not see their first birthday and half of them do not reach their second birthday. Early detection of pediatric HIV is crucial for prevention of morbidities, growth delays and death. Methods: The study aimed to estimate the disease burden of pediatric HIV among children in ‘A’ category district of a high HIV prevalence state. The study used an innovative multipronged methodology to estimate the disease burden in a high burden district in India. Details of methodology have been published and include early case detection in infants (0-18 months) born to HIV positive women, among children in families with HIV positive parents, and among sick children (0 to 14 years) presenting in a health facility and screened using a modified IMCI-HIV algorithm, were methods used. The overall burden of paediatric HIV was calculated as a product of cases detected in each strategy multiplied by a net inflation factor for each strategy.Results: The existing pool of HIV infection in the district works out to be 3266 HIV positive children <15 years of age, among a mid-year (2013) projected child population of 1401688, thus giving us an overall HIV prevalence among children of 0.23%. The proportion of children among all people living with HIV in the district works out to 10.4% (3266/ (3266+28119)Conclusions: The study reported a higher prevalence than reported earlier from projections of the NACP. An overall 0.23% HIV prevalence among children was estimated which is 2.5 times that of the earlier reported prevalence for Karnataka state. The proportion of children among all persons living with HIV in Belgaum district in this study is 10.4% against 6.54% reported earlier for India. The study methodology is replicable for other settings and other diseases.

Care Burden and Coping Strategies Among Caregivers of Paediatric HIV/AIDS in Northern Uganda: A Cross-sectional Mixed-method Study

Background: Family caregivers provide the bulk of care to children living with HIV. This places an enormous demand and care burden on the caregivers, who often struggle to cope in various ways, some of which may be maladaptive. This may adversely affect their quality of care. Very few literatures exist in resource-limited contexts on the burden of care experienced by caregivers on who children living with HIV/AIDS depend for their long term care. We assessed care burden and coping strategies among the caregivers of paediatric HIV/AIDS patients in Lira district, northern Uganda. Methods: A mixed-methods cross-sectional study was conducted among 113 caregivers of paediatric HIV patients attending ART clinic at a tertiary healthcare facility in Lira district, northern Uganda. Consecutive sampling method was used to select participants for the quantitative study, while 15 respondents were purposively sampled for the qualitative data. Quantitative data were collected using standard interviewer-administered questionnaires while in-depth interview guides were used to collect qualitative data. Data were entered, cleaned, and analysed using SPSS version 23. Qualitative data were analysed thematically. Results: Majority of the caregivers 65.5% (74) experienced mild to moderate burden. The mean burden scores significantly differed by caregivers’ age ( P =0.017), marital status ( P =0.017), average monthly income ( P =0.035) and the child’s school attendance ( P =0.039). Accepting social support, seeking spiritual support and reframing were the three most commonly used strategies for coping. Marital status and occupation were respectively positively and negatively correlated with information seeking as a coping strategy, while monthly income was positively correlated with psychosocial support as a strategy. Seeking community support was negatively correlated with the duration of the child's care. Conclusions: Our findings show that care burden is a common problem among the caregivers of children living with HIV in the study context.

A Review to Identify the Gaps in Prevention of Mother to Child Transmission of HIV Services in Nigeria

Background: Nigeria has the second largest burden of maternal to child transmission of HIV (MTCT) in the world at a rate of 30% and has the largest burden of paediatric HIV infection globally at the rate of 10%. Effective prevention of mother to child transmission of HIV (PMTCT) can drastically reduce the paediatric HIV infection to 2%. However, recent evidence reveals yawning gaps in the PMTCT services in Nigeria, where out of estimated 9.2 million pregnancies, only about 3 million received HIV counselling and testing (HCT). This review is to unravel the unmet needs for PMTCT of HIV services in Nigeria. Methods: Keywords from objectives of review are MTCT and PMTCT which were used to search for related literatures through online libraries of national and international journals; Medline and PubMed including google. 62 related literatures/studies were initially generated and then narrowed down to 19 literatures were selected which met the inclusion criteria- less than 10 year and related to objective of review. Findings: There are unmet needs for PMTCT of HIV services in Nigeria due to challenges like low HCT/PMTCT service uptake (35.5%), low HCT/PMTCT service delivery facilities (27%), low ANC (58%) and low (35%) delivery in formal health setting. Conclusion: PMTCT target in Nigeria has not been met. Regular training of existing health workforce including the TBAs and the adoption of the recommendations for an HIV-free generation will bridge the HCT / PMTCT of HIV services gap identified in this review.

Immunovirological treatment outcomes after 2 years of antiretroviral therapy in children living with the human immune deficiency virus in Lagos Nigeria

Background/objective: The World Health Organization (WHO) recommends routine assessment of antiretroviral treatment outcomes to detect treatment failure early and prevent the development of drug resistance. The aim of this study was to describe treatment outcomes of antiretroviral therapy (ART) over 2 years in children living with the human immune deficiency virus enrolled in the paediatric HIV clinic at the Lagos UniversityTeaching Hospital (LUTH).Materials and methods: This was a retrospective study of antiretroviral treatment outcomes in 278 children receiving antiretroviral therapy at the paediatric HIV clinic of LUTH. Demographic, clinical and laboratory data were retrospectively collected from clinical records of pediatric patientswho received antiretroviral therapy for 2 years ( from November 2015 to December 2017) . Virological failure was defined as viral load > 400 copies/ml and immunological failure was defined as a CD4 count <100 cells/mm3 or CD4 % <15% after receiving antiretroviral agents for 12 months. Data was analysed using graph pad prism version 5.0.Results: After 12 months on antiretroviral therapy (ART), 101 (36%) had virological failure while 14 (5%) and 36 (13%) failed immunologically [CD4 count <100 cells/mn3 and CD4 <15% respectively]. Virological blips were observed at 24 months in 6.1% of patients while immunovirological discordance occurred in 30% of patients (poor virological clearance despite good immunological recovery) . High baseline viral load (>5000 copies/ml), poor adherence (<95%) and low baseline CD4 counts (101-249 cells/mn3) were significantly associated with virological failure, while low baseline CD4 counts (<350 cells/mn3) and poor adherence (<95%) were significantly associated with immunologic failure.Conclusion: The treatment outcomes observed in this study are similar to those reported in earlier studies. At 1 and 2 years of antiretroviral therapy , there was immune restoration however 101 (36%) and 87 (31%) respectively had virological failure despite good adherence to therapy and good Immunological restoration. This calls for early initiation and switch to second and third line drugs . Key words: Human immunodeficiency virus (HIV), zidovudine, lamivudine, nevirapine, virological blips, immunovirological discordance , children, Nigeria.