Opportunistic Infections and Hepatitis

Opportunistic infections (OIs) are infections affecting HIV patients with weakened immunity, indicated by a white blood cell count below 200 cells/cm³ (14%).

• Advanced HIV infection makes individuals vulnerable to opportunistic infections or malignancies. These infections exploit the weakened immune system.
• Childhood acquisition of OIs and HIV often occurs from infected mothers.
• Women living with HIV are more prone to co-infections with opportunistic pathogens, increasing the risk of transmission to their infants.
• Adolescents with HIV, including long-time survivors of perinatal infection, are increasingly common. Treatment guidelines also apply to youth living with HIV who have not yet completed pubertal development.

• Poor adherence to treatment
• Presence of other diseases (e.g., juvenile diabetes mellitus)
• Delay in identification of the infection
• High viral load
• Poor nutrition
• Exposure to opportunistic infectious agents
• Ingestion of substances contaminated with opportunistic infectious agents
• Missing out on immunization programs
• Poor hygiene
• Poor sanitation
• Poor ventilation

• Avoidance of contact with the disease agents
• Proper treatment of other underlying diseases
• Adherence to HIV drug treatment
• Immunization of children against killer diseases
• Ensuring that children consume well-cooked food and boiled water
• Early identification and treatment of opportunistic diseases
• Health education of the family and infected child about opportunistic infections

Hepatitis B is a chronic liver infection characterized by inflammation of hepatocytes caused by the hepatitis B virus.

• High : Blood
• Moderate : Semen, Urine, Serum, Wound exudate, Vaginal fluid
• Low/Not Detectable : Saliva, Feces, Sweat, Tears, Breast milk

• Immune Tolerance : Represents the incubation period, lasting approximately 2-4 weeks in healthy adults, and often decades in newborns.
• Immune Active/Immune Clearance : Inflammatory reaction occurs with active viral replication. Duration varies; for acute infection, approximately 3-4 weeks; for chronic infection, up to 10 years.
• Inactive Chronic Infection : Host targets infected hepatocytes and HBV, with low or no measurable viral replication in serum. Anti-HBe can be detected.
• Chronic Disease: Chronic HBeAg-negative disease may emerge.
• Recovery : Virus undetectable in blood, antibodies to viral antigens produced.

Symptoms can be symptomatic or asymptomatic:

• Weakness, malaise, low-grade fever
• Nausea, loss of appetite, vomiting
• Pain or tenderness over right upper abdomen
• Jaundice, dark urine, severe pruritus
• Enlarged liver
• Complications: liver cirrhosis, hepatocarcinoma

• Hepatitis B surface antigen positive for >6 months
• Hepatitis B core antibody: Negative IgM and Positive IgG to exclude acute hepatitis B infection
• Liver tests, repeated at 6 months
• HBeAg (can be positive or negative)
• HBV DNA if available
• HIV serology
• APRI (AST to Platelets Ratio Index): a marker for fibrosis
• Alpha fetoprotein at 6 months
• Abdominal ultrasound at 4-6 months

General Principles:

• Screen for HIV and refer if positive.
• Refer to a regional hospital for specialist management if HIV is negative.
• Antiviral treatment is given to prevent complications and usually for life.
• Patients with chronic hepatitis B need periodic monitoring and follow-up for life.
• Periodic screening for hepatocarcinoma with alfa fetoprotein and abdominal ultrasound once a year.

• Treat with antivirals based on specific criteria.

First-line antivirals:

• Adults and children >12 years or >35 kg: tenofovir 300 mg once a day
• Child 2-11 years (>10 kg): Entecavir 0.02 mg/kg

Health Education:

• Management is lifelong.
• Bed rest is recommended.
• Avoid alcohol as it worsens the disease.
• Immunization of household contacts.
• Do not share items that the patient puts in the mouth (e.g. toothbrushes, cutlery, razor blades).