title: Evolution of hepatitis B serological markers in HIV coinfected patients: a case study.
abstract: OBJECTIVE
  To describe the evolution of serological markers among HIV and hepatitis B coinfected patients, with emphasis on evaluating the reactivation or seroreversion of these markers.
  
  
  METHODS
  The study population consisted of patients met in an AIDS Outpatient Clinic in São Paulo State, Brazil. We included in the analysis all HIV-infected and who underwent at least two positive hepatitis B surface antigen serological testing during clinical follow up, with tests taken six months apart. Patients were tested with commercial kits available for hepatitis B serological markers by microparticle enzyme immunoassay. Clinical variables were collected: age, sex, CD4+ T-cell count, HIV viral load, alanine aminotransferase level, exposure to antiretroviral drugs including lamivudine and/or tenofovir.
  
  
  RESULTS
  Among 2,242 HIV positive patients, we identified 105 (4.7%) patients with chronic hepatitis B. Follow up time for these patients varied from six months to 20.5 years. All patients underwent antiretroviral therapy during follow-up. Among patients with chronic hepatitis B, 58% were hepatitis B "e" antigen positive at the first assessment. Clearance of hepatitis B surface antigen occurred in 15% (16/105) of patients with chronic hepatitis B, and 50% (8/16) of these patients presented subsequent reactivation or seroreversion of hepatitis B surface antigen. Among hepatitis B "e" antigen positive patients, 57% (35/61) presented clearance of this serologic marker. During clinical follow up, 28.5% (10/35) of those who initially cleared hepatitis B "e" antigen presented seroreversion or reactivation of this marker.
  
  
  CONCLUSIONS
  Among HIV coinfected patients under antiretroviral therapy, changes of HBV serological markers were frequently observed. These results suggest that frequent monitoring of these serum markers should be recommended.
authors.affiliation: Instituto de Infectologia Emílio Ribas. São Paulo, SP, Brasil.|Departamento de Doenças Infecciosas. Faculdade de Medicina. Universidade de São Paulo. São Paulo, SP, Brasil.
authors.forename: Ana Luiza de Castro Conde
authors.initials: AL
authors.lastname: Toscano
authors.affiliation: Departamento de Doenças Infecciosas. Faculdade de Medicina. Universidade de São Paulo. São Paulo, SP, Brasil.|Instituto de Medicina Tropical de São Paulo. Laboratório de Investigação Médica 52. São Paulo, SP, Brasil.
authors.forename: Maria Cássia Mendes
authors.initials: MC
authors.lastname: Corrêa
mesh_terms: D015415:Biomarkers / Q000097:blood; D015496:CD4-Positive T-Lymphocytes; D060085:Coinfection; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006514:Hepatitis B Surface Antigens / Q000097:blood* / Q000276:immunology; D006513:Hepatitis B e Antigens / Q000097:blood* / Q000276:immunology; D006515:Hepatitis B virus / Q000276:immunology*; D019694:Hepatitis B, Chronic / Q000150:complications / Q000276:immunology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D000069078:Seroconversion; D019562:Viral Load
chemical_list: D015415:Biomarkers; D006514:Hepatitis B Surface Antigens; D006513:Hepatitis B e Antigens