Molecular characterization of occult and overt hepatitis B (HBV) infection in an HIV-infected person with reactivation of HBV after antiretroviral treatment interruption.
BACKGROUND
Occult HBV infection is characterized by the absence of surface antigenemia and the presence of potentially infectious hepatitis B virus (HBV)-DNA present in liver, serum, or both. Reactivation of chronic HBV infection in the presence of the HBV surface antigen (HBsAg) is a well-known complication in immunocompromised individuals under cytotoxic chemotherapy or in HIV-infected individuals when nucleos(t)ide analogs effective against HIV/HBV are discontinued. However, little is known on the possibility of such a complication in HIV-infected persons with HBV-core antibody (anti-HBc) as the sole serological marker of past HBV infection.


METHODS
Here we report the case of one HIV-infected, anti-HBc-positive individual who showed a severe reactivation of HBV after the interruption of antiretroviral therapy (ART).


RESULTS
Analysis of the plasma samples revealed HBV-DNaemia, albeit at very low levels in the latent phase, while the HBV-DNA level was highly increased during the overt phase that corresponded to the period of ART interruption, decreasing dramatically after the subsequent introduction of tenofovir-based ART. Molecular analysis of HBV in the two phases showed that overt HBV infection was due to reactivation of the occult HBV rather than to reinfection.


CONCLUSIONS
Our case underlines the possibility that occult HBV infection may still have the potential to be severely reactivated in HIV-infected individuals, particularly when antiretroviral treatment is discontinued.
Department of Infectious Diseases, San Raffaele Scientific Institute, via Stamira d'Ancona, 20, 20127 Milan, Italy.
S
S
Bagaglio
L
L
Porrino
A
A
Lazzarin
G
G
Morsica
D000595:Amino Acid Sequence; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000821:virology; D006509:Hepatitis B / Q000150:complications / Q000821:virology*; D006515:Hepatitis B virus / Q000276:immunology / Q000302:isolation & purification / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008969:Molecular Sequence Data; D014775:Virus Activation / Q000187:drug effects; D028761:Withholding Treatment
D019380:Anti-HIV Agents