title: Prevalence, risk factors, and outcomes for occult hepatitis B virus infection among HIV-infected patients.
abstract: BACKGROUND
  Occult hepatitis B virus (HBV) is defined by the presence of HBV DNA in individuals with HBV core antibodies (anti-HBc) but without HBV surface antigen (HBsAg). The prevalence of occult HBV in HIV-infected patients remains controversial, and the risk factors and clinical significance are unknown.
  
  
  OBJECTIVE
  To determine the prevalence, risk factors, and clinical significance of occult HBV among HIV-infected patients. Hypothesized risk factors include chronic hepatitis C virus (HCV), CD4 count < 200 cells/mm, HIV RNA level >1000 copies/mL, and lack of use of anti-HBV antiretrovirals.
  
  
  METHODS
  We examined randomly selected HBsAg/anti-HBc HIV-infected patients in the Penn Center for AIDS Research Adult/Adolescent Database and Specimen Repository. HBV DNA was qualitatively detected using a transcription-mediated amplification assay. Risk factors and transaminases were ascertained at the time sera were collected.
  
  
  RESULTS
  A total of 699 HBsAg/anti-HBc HIV-infected patients were identified. Of 179 randomly selected subjects, 17 (10%; 95% confidence interval [CI]: 5% to 14%) had occult HBV. Differences in the prevalence of HBV surface antibody (anti-HBs) between those with (7 [41%]) and without (94 [58%]) occult HBV were not statistically significant (P = 0.3). An HIV RNA level >1000 copies/mL (adjusted odds ratio [OR] = 4.88, 95% CI: 1.01 to 30.26) and the absence of chronic HCV (adjusted OR = 0.26, 95% CI: 0.05 to 0.95) were associated with occult HBV. Occult HBV did not increase the risk of transaminitis (adjusted OR = 0.42, 95% CI: 0.12 to 1.45).
  
  
  CONCLUSIONS
  Occult HBV occurred in a sizable proportion of HIV-infected patients and was associated with detectable HIV and the absence of chronic HCV. It did not increase the risk of transaminitis. The presence of anti-HBs does not rule out occult HBV. Future studies should examine the long-term clinical implications of occult HBV in HIV-infected patients.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, University of Pennsylvania School of Medicine, 423 Guardian Drive, Philadelphia, PA 19104, USA. vincent.lore@uphs.upenn.edu
authors.forename: Vincent
authors.initials: V
authors.lastname: Lo Re
authors.forename: Ian
authors.initials: I
authors.lastname: Frank
authors.forename: Robert
authors.initials: R
authors.lastname: Gross
authors.forename: Janel
authors.initials: J
authors.lastname: Dockter
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Linnen
authors.forename: Cristina
authors.initials: C
authors.lastname: Giachetti
authors.forename: Pablo
authors.initials: P
authors.lastname: Tebas
authors.forename: John
authors.initials: J
authors.lastname: Stern
authors.forename: Marie
authors.initials: M
authors.lastname: Synnestvedt
authors.forename: A Russell
authors.initials: AR
authors.lastname: Localio
authors.forename: Jay R
authors.initials: JR
authors.lastname: Kostman
authors.forename: Brian L
authors.initials: BL
authors.lastname: Strom
mesh_terms: D000328:Adult; D004279:DNA, Viral / Q000097:blood; D005260:Female; D015658:HIV Infections / Q000150:complications*; D015497:HIV-1 / Q000302:isolation & purification; D016174:Hepacivirus / Q000302:isolation & purification; D006509:Hepatitis B / Q000453:epidemiology* / Q000503:physiopathology / Q000821:virology; D006510:Hepatitis B Antibodies / Q000097:blood; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006515:Hepatitis B virus / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D008875:Middle Aged; D021141:Nucleic Acid Amplification Techniques; D015143:Philadelphia; D015995:Prevalence; D012367:RNA, Viral / Q000032:analysis; D012307:Risk Factors; D013223:Statistics as Topic; D000637:Transaminases / Q000097:blood; D019562:Viral Load
chemical_list: D004279:DNA, Viral; D006510:Hepatitis B Antibodies; D006514:Hepatitis B Surface Antigens; D012367:RNA, Viral; D000637:Transaminases