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Hepatitis B and C virus co-infection in black children with membranous nephropathy
Nomathamsanqa P Sithebe1, Anna Kramvis, Michael C Kew
1MRC/CANSA University Molecular Hepatology Research Unit, Department of Medicine, University of the Witwatersrand, Johannesburg, South Africa.
Abstract:
Membranous glomerulonephritis is a recognized complication of hepatitis B virus infection, especially in children, and an occasional complication of hepatitis C virus infection. Co-infection with the two viruses has not previously been described in membranous glomerulonephritis. We report five black African children with membranous glomerulonephritis who were co-infected with hepatitis B and C viruses. Proof of hepatitis B virus infection was obtained using serological and molecular detection methods. Hepatitis C virus infection was demonstrated using reverse transcription to convert viral RNA to cDNA followed by amplification of the cDNA using a double round of the polymerase chain reaction with confirmation by Southern hybridization and nucleotide sequencing. The clinical, biochemical, immunological, and pathological characteristics of the co-infected children, as well as the natural history of the disease, did not differ from those in 24 children with hepatitis B virus-associated membranous glomerulonephritis. Of the 24 family and household contacts of the five co-infected children, 7 were infected with hepatitis B virus, 1 with hepatitis C virus, and none with both viruses. It is not known whether infection with the two viruses was acquired simultaneously or sequentially. Thus, black children with membranous glomerulonephritis are occasionally co-infected with hepatitis B and C viruses. The resulting disease appears to be no more severe than that in children infected with hepatitis B virus alone.
Insights
Hepatitis B and C virus co-infection is a rare cause of membranous glomerulonephritis in Black African children. This co-infection does not appear to worsen the disease compared to hepatitis B virus infection alone.
Area of Science:
- Nephrology
- Hepatology
- Infectious Diseases
Background:
- Membranous glomerulonephritis (MGN) is a known complication of Hepatitis B virus (HBV) and Hepatitis C virus (HCV) infections.
- Co-infection with HBV and HCV in MGN has not been previously documented.
Purpose of the Study:
- To describe the first reported cases of HBV and HCV co-infection in Black African children with MGN.
- To compare the clinical, biochemical, immunological, and pathological characteristics of co-infected children with those infected with HBV alone.
Main Methods:
- Serological and molecular methods were used to confirm HBV infection.
- Reverse transcription-polymerase chain reaction (RT-PCR) with Southern hybridization and sequencing confirmed HCV infection.
- Clinical data and pathological findings were analyzed and compared between co-infected and HBV-monoinfected children.
Main Results:
- Five Black African children with MGN were found to be co-infected with HBV and HCV.
- The clinical presentation, biochemical markers, immunological status, and pathological features of co-infected children were similar to those with HBV-associated MGN.
- Among family contacts, HBV and HCV infections were observed, but no co-infections were detected.
Conclusions:
- HBV and HCV co-infection can occur in Black African children with MGN.
- The disease course in co-infected children appears similar to that in children with HBV-associated MGN, suggesting no increased severity.