Objectives To provide a review of prevalence, management and outcomes of children with HIV coinfected with either hepatitis B or C virus (HBV/HCV) attending two large city hospitals.
Background Management guidelines for coinfected adults are established both in Europe and the US. However, there is a paucity of data on paediatric coinfection, particularly from European cohorts.
Methods Identify coinfected children from the paediatric HIV cohorts at the two hospitals. Review clinical records including immunology, biochemistry, virology and histopathology reports, to provide a retrospective analysis of patient care.
Results Five children coinfected with HBV and 1 child with HCV were identified from a total cohort of 236 children. Not all children had been screened for co-infection. In HBV coinfection, viral loads for both diseases were found to be suppressed to undetectable levels on combination regimes containing drugs effective against both viruses. Successive liver biopsies showed a marked improvement in the degree of liver injury (see figure 1). The HCV coinfected individual was treated only with drugs active against HIV, and a progressive rise in HCV viral load was seen. Consecutive liver biopsies showed worsening inflammation.
Conclusions The medium-term outcome for children with HIV/HBV coinfection appears to be excellent, but HCV coinfection poses greater therapeutic challenges. All children in the paediatric HIV cohort should be screened for coinfection. Susceptible children and their family members should be vaccinated against HBV.
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