title: Incidence of transaminitis among HIV-infected patients with occult hepatitis B.
abstract: BACKGROUND
  The clinical significance of occult hepatitis B virus (HBV) infection, defined as the presence of HBV DNA in individuals with HBV core antibodies (anti-HBc) in the absence of HBV surface antigen (HBsAg), is unclear in HIV-infected patients. This information is needed to determine the importance of detecting and treating occult HBV in this population.
  
  
  OBJECTIVE
  To determine if HIV-infected patients with occult HBV infection have an increased incidence of transaminitis.
  
  
  METHODS
  We performed a cohort study among randomly selected HBsAg-/anti-HBc+ HIV-infected patients in the Penn CFAR Database and Specimen Repository. HBV DNA was qualitatively detected using a transcription-mediated amplification assay. Hepatic transaminase levels, the main study outcome, were collected at 6-month intervals from the time of occult HBV determination.
  
  
  RESULTS
  Among 97 randomly selected subjects without baseline transaminitis, 13 (13%) had occult HBV. These subjects more frequently had detectable HIV RNA. The 2-year incidence of transaminitis among HIV-infected subjects with occult HBV (50 events/100 person-years) was not significantly different from those without occult HBV (38 events/100 person-years; adjusted incidence rate ratio=1.36 [95% CI, 0.72-2.59]).
  
  
  CONCLUSIONS
  Occult HBV did not increase the incidence of hepatic transaminitis over 2 years. Future studies should determine whether occult HBV is associated with other clinically important outcomes, particularly hepatocellular carcinoma.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA 19104-6021, USA. vincent.lore@uphs.upenn.edu
authors.forename: Vincent
authors.initials: V
authors.lastname: Lo Re
authors.forename: Benjamin
authors.initials: B
authors.lastname: Wertheimer
authors.forename: A Russell
authors.initials: AR
authors.lastname: Localio
authors.forename: Jay R
authors.initials: JR
authors.lastname: Kostman
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: Zachariah
authors.initials: Z
authors.lastname: Dorey-Stein
authors.forename: Ian
authors.initials: I
authors.lastname: Frank
authors.forename: Brian L
authors.initials: BL
authors.lastname: Strom
authors.forename: Robert
authors.initials: R
authors.lastname: Gross
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood*; D001219:Aspartate Aminotransferases / Q000097:blood*; D015331:Cohort Studies; D004279:DNA, Viral / Q000097:blood; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000201:enzymology; D006509:Hepatitis B / Q000150:complications* / Q000201:enzymology; D006510:Hepatitis B Antibodies / Q000097:blood; D006515:Hepatitis B virus / Q000302:isolation & purification; D006801:Humans; D008099:Liver / Q000201:enzymology* / Q000821:virology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016012:Poisson Distribution; D018709:Statistics, Nonparametric
chemical_list: D004279:DNA, Viral; D006510:Hepatitis B Antibodies; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase