The prevalence and significance of occult hepatitis B virus in a prospective cohort of HIV-infected patients.
BACKGROUND
Occult hepatitis B virus (HBV) is defined as low-level HBV DNA without hepatitis B surface antigen (HBsAg). Prevalence estimates vary widely. We determined the prevalence of occult HBV at the University of Cincinnati Infectious Diseases Center (IDC).


METHODS
Patients in the IDC HIV database (n = 3867) were randomly selected using a 25% sampling fraction. Samples were pooled for HBV nucleic acid extraction. Pools were tested for HBV DNA by a real-time polymerase chain reaction (PCR) assay to co-amplify core/surface protein regions. The PCR assay was run on all individual samples from each DNA pool. DNA samples were tested for HBV serologic markers.


RESULTS
A total of 909 patients without known HBV were selected. The mean CD4 count was 384 cells/mm. Forty-three patients were HBV DNA. Twelve of 43 were DNA/HBsAg (95% confidence interval for database: 0.58% to 1.90%). Five of 12 were negative for all serologic markers. Alanine aminotransferase, aspartate aminotransferase, and HBV DNA titers were elevated in HBsAg patients versus occult patients and versus HIV-monoinfected patients. No other significant differences were detected. No occult HBV patient was on treatment with anti-HBV activity.


CONCLUSIONS
Forty-three percent of those with HBV were not previously identified as HBV, indicating the need for ongoing screening in high-risk populations. Occult HBV may occur in persons with all negative serologic markers, representing a challenge for identification.
Shire
Norah J
NJ
Division of Digestive Diseases, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH 45267, USA. norah.shire@uc.edu
Rouster
Susan D
SD
Stanford
Sandra D
SD
Blackard
Jason T
JT
Martin
Christina M
CM
Fichtenbaum
Carl J
CJ
Sherman
Kenneth E
KE
D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D004279:DNA, Viral / Q000097:blood / Q000235:genetics; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006509:Hepatitis B / Q000150:complications* / Q000453:epidemiology* / Q000821:virology; D006510:Hepatitis B Antibodies / Q000097:blood; D006512:Hepatitis B Core Antigens / Q000276:immunology; D006514:Hepatitis B Surface Antigens / Q000032:analysis; D006515:Hepatitis B virus / Q000302:isolation & purification; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009820:Ohio / Q000453:epidemiology; D016133:Polymerase Chain Reaction; D015995:Prevalence; D012307:Risk Factors
D004279:DNA, Viral; D006510:Hepatitis B Antibodies; D006512:Hepatitis B Core Antigens; D006514:Hepatitis B Surface Antigens; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase