title: The perils of relying on anti-hepatitis B total core antibody in screening individuals infected with HIV.
abstract: Co-infection with HIV and hepatitis B virus (HBV) has serious long-term consequences. We describe a case of an HIV-infected heterosexual black African man with a delayed diagnosis of HBV infection. Baseline HBV screening was performed using a sequential testing algorithm starting with a total core antibody (anti-HBc) test, which was negative. He had no evidence of immunity against HBV and subsequently received three unsuccessful courses of HBV vaccination. He had mild but persistent elevation of liver enzymes over a five-year period despite maintaining full suppression of HIV replication on efavirenz, lamivudine and zidovudine; the latter was changed to abacavir due to lipoatrophy. Further testing revealed e-antibody positive chronic HBV infection with undetectable anti-HBc reactivity. High-grade HBV viraemia associated with L180M and M240V drug-resistance mutations was confirmed. He was subsequently switched to a tenofovir-based regimen, which achieved HBV suppression. Adopting effective HBV screening strategies in HIV-infected patients is recommended.
authors.affiliation: Department of Genitourinary Medicine, Manchester Royal Infirmary, Oxford Road, Manchester, UK. caroline.thng@cmft.nhs.uk
authors.forename: C
authors.initials: C
authors.lastname: Thng
authors.forename: Z O E
authors.initials: ZO
authors.lastname: Babiker
authors.forename: B
authors.initials: B
authors.lastname: Brown
authors.forename: C
authors.initials: C
authors.lastname: Babu
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use; D060085:Coinfection; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000821:virology; D006510:Hepatitis B Antibodies / Q000097:blood*; D006512:Hepatitis B Core Antigens / Q000276:immunology*; D017325:Hepatitis B Vaccines / Q000008:administration & dosage / Q000276:immunology; D006515:Hepatitis B virus / Q000276:immunology; D019694:Hepatitis B, Chronic / Q000175:diagnosis* / Q000276:immunology / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents; D006510:Hepatitis B Antibodies; D006512:Hepatitis B Core Antigens; D017325:Hepatitis B Vaccines