Biological dynamics of hepatitis B virus load in dialysis population.
BACKGROUND
Control of the spread of hepatitis B virus (HBV) infection in dialysis units has been one of major advances in the management of end-stage renal disease. However, the natural history of HBV in dialysis patients remains unclear. The aim of this study is to measure monthly HBV viral load (HBV DNA) in a large cohort (n = 29) of hepatitis B surface antigen (HBsAg)-positive chronic dialysis patients during 12 months.


METHODS
HBV DNA was measured using the Amplicor HBV Monitor Test (Roche Diagnostics, Branchburg, NJ), an in vitro assay using polymerase chain reaction nucleic acid amplification and DNA hybridization for the quantitative measurement of HBV DNA in serum.


RESULTS
We observed three HBV DNA patterns: (1) patients persistently positive by Amplicor HBV Monitor Test (persistent HBV DNA; 7 of 29 patients; 24.1%), (2) individuals with alternatively positive and negative results (intermittent HBV DNA; 18 of 29 patients; 62.1%), and (3) patients persistently negative by Amplicor HBV Monitor Test (4 of 29 patients; 13.8%). HBV viral load was greater in patients with persistent compared with intermittent HBV DNA (persistently HBV DNA positive; 2.686 x 10(4) copies/mL; 95% confidence interval [CI], 5.2499 x 10(4) to 1.8158 x 10(4)copies/mL) versus intermittently HBV DNA positive (1.071 x 10(3) copies/mL; 95% CI, 8.524 x 10(3) to 4.09 x 10(2) copies/mL; P = 0.0001). In the entire group, HBV load at study entry was low and did not change versus the end of follow-up.


CONCLUSIONS
Three patterns of HBV viremia in dialysis patients over time were assessed; HBV load was not high and was relatively stable. HBsAg-positive patients who were intermittently HBV DNA positive had less HBV viral load than persistently HBV DNA-positive patients. Periodic testing for HBV DNA to assess the virological status of HBsAg-positive dialysis patients is recommended.
Fabrizi
Fabrizio
F
Nephrology and Dialysis Division, Institute of Hygiene and Preventive Medicine, Maggiore Hospital, IRCCS, Milano, Italy. fabrizi@policlinico.mi.it
Lunghi
Giovanna
G
Alongi
Giancarlo
G
Bisegna
Sergio
S
Campolo
Gesualdo
G
Mangano
Stefano
S
Limido
Aurelio
A
Pagliari
Bruno
B
Tettamanzi
Fabio
F
Ponticelli
Claudio
C
D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D015331:Cohort Studies; D004279:DNA, Viral / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006514:Hepatitis B Surface Antigens / Q000097:blood; D019694:Hepatitis B, Chronic / Q000150:complications / Q000821:virology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis; D019562:Viral Load; D014766:Viremia / Q000150:complications / Q000821:virology*
D004279:DNA, Viral; D006514:Hepatitis B Surface Antigens; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase