Predictors and kinetics of occult hepatitis B virus infection in HIV-infected persons.
It has been proposed that occult hepatitis B virus (HBV) infection, defined as detectable HBV-DNA in serum with undetectable surface antigen (HBsAg(-)), is associated with raised transaminases in HIV-infected persons. The aim of this study was to determine the prevalence of occult HBV infection in two independent cohorts, and investigate its predictors, association with alanine-aminotransferase (ALT) levels and response to antiretroviral therapy. Sera from HBsAg(-) persons with core antibody (anti-HBc(+)) were tested by real-time PCR. Overall, 5.2% of patients were HBsAg(+) and 39% HBsAg(-)/anti-HBc(+). The prevalence of occult HBV infection was 48/343 (14.0%; 95% CI 10.7-18.1%), and 27/196 (13.8%) and 21/147 (14.3%) in the two cohorts. Median HBV-DNA load was 342 (51-147,500) and 60 (25-33,850) copies/ml respectively. HBV-DNA detection was associated with absence of surface antibody (anti-HBs), but not with CD4 or ALT levels. Among 11 HBV-DNA(+) persons who started antiretroviral therapy containing lamivudine or lamivudine/tenofovir, HBV-DNA was repeatedly undetectable over median 19 (3-43) months. However, HBV-DNA detection was intermittent among drug-naïve persons. Occult HBV infection is common in HBsAg(-)/anti-HBc(+) HIV-infected patients and predicted by undetectable anti-HBs. The intermittent nature of HBV-DNA detection poses a diagnostic challenge, but no association is observed with ALT levels.
Nebbia
Gaia
G
Department of Virology, Royal Free Hospital and Royal Free & University College Medical School, London, UK.
Garcia-Diaz
Ana
A
Ayliffe
Ursula
U
Smith
Colette
C
Dervisevic
Samir
S
Johnson
Margaret
M
Gilson
Richard
R
Tedder
Richard
R
Geretti
Anna Maria
AM
D000225:Adenine / Q000031:analogs & derivatives / Q000627:therapeutic use; D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D015415:Biomarkers / Q000097:blood; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology; D002353:Carrier State / Q000097:blood / Q000453:epidemiology; D015331:Cohort Studies; D004279:DNA, Viral / Q000097:blood; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000276:immunology; D015497:HIV-1; D006509:Hepatitis B / Q000097:blood / Q000453:epidemiology*; D006510:Hepatitis B Antibodies / Q000097:blood; D006512:Hepatitis B Core Antigens / Q000276:immunology; D006514:Hepatitis B Surface Antigens / Q000097:blood*; D006515:Hepatitis B virus / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D019259:Lamivudine / Q000627:therapeutic use; D008131:London / Q000453:epidemiology; D008297:Male; D063065:Organophosphonates / Q000627:therapeutic use; D015995:Prevalence; D000068698:Tenofovir
D019380:Anti-HIV Agents; D015415:Biomarkers; D004279:DNA, Viral; D006510:Hepatitis B Antibodies; D006512:Hepatitis B Core Antigens; D006514:Hepatitis B Surface Antigens; D063065:Organophosphonates; D019259:Lamivudine; D000068698:Tenofovir; D000410:Alanine Transaminase; D000225:Adenine