Impact of occult hepatitis B virus infection in HIV patients naive for antiretroviral therapy.
OBJECTIVE
To study the impact of occult hepatitis B virus (HBV) infection in 115 consecutive anti-HIV-positive, hepatitis B surface antigen-negative patients, naive for antiretroviral treatment.


METHODS
Of these 115, 86 patients were followed for at least 6 months (range 6-36) with serial determinations of HIV RNA and HBV DNA by polymerase chain reaction and other laboratory tests.


RESULTS
Of the 86 patients having a follow-up, plasma HBV DNA was detected in 17 (19.8%), 13 on admission and four during follow-up. HBV DNA was more frequently found in patients with isolated anti-hepatitis B core (HBc; 35.5% of 31 cases) than in those lacking anti-HBc and anti-hepatitis B surface (8.8% of 41, P < 0.005), or showing both (21.4% of 14). Twenty-eight patients (32.5%) experienced a hepatic flare during the follow-up; this event was more frequent in the 17 HBV-DNA-positive patients than in the 69 negative (64.7% versus 24.6%, P < 0.005). Of the 13 HBV-DNA-positive patients on admission, 11 receiving HAART containing lamivudine became HBV-DNA negative, but two of these again became positive and experienced a hepatic flare during treatment and two both during and after lamivudine treatment. A hepatic flare also occurred under lamivudine treatment in two of the four patients in whom HBV DNA became detectable during follow-up. The role of immune reconstitution inflammatory syndrome and HAART in inducing a hepatic flare was found to be marginal in 49 patients with no HBV or hepatitis C virus marker.


CONCLUSIONS
The study suggests that HBV occult infection, relatively frequent in anti-HIV-positive patients, is associated with hepatic flares.
Filippini
Pietro
P
Department of Public Medicine, Section of Infectious Diseases, Second University of Naples, c/o Ospedale Gesù e Maria, Via D. Cotugno 1, 80135 Naples, Italy.
Coppola
Nicola
N
Pisapia
Raffaella
R
Scolastico
Carlo
C
Marrocco
Cecilia
C
Zaccariello
Antonella
A
Nacca
Cesare
C
Sagnelli
Caterina
C
De Stefano
Giulio
G
Ferraro
Teresa
T
De Stefano
Carlo
C
Sagnelli
Evangelista
E
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D000998:Antiviral Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D016009:Chi-Square Distribution; D004279:DNA, Viral / Q000097:blood; D005260:Female; D005434:Flow Cytometry; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D015497:HIV-1 / Q000235:genetics / Q000276:immunology; D006509:Hepatitis B / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D006512:Hepatitis B Core Antigens / Q000097:blood; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006515:Hepatitis B virus / Q000235:genetics / Q000276:immunology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012367:RNA, Viral / Q000097:blood; D012307:Risk Factors
D000998:Antiviral Agents; D004279:DNA, Viral; D006512:Hepatitis B Core Antigens; D006514:Hepatitis B Surface Antigens; D012367:RNA, Viral