Impact of Occult HBV Infection in HIV/HCV Co-Infected Patients: HBVDNA Detection in Liver Specimens and in Serum Samples

Abstract

Prevalence and impact of occult HBV infection in HIV positive patients is controversial. The aims of this study were to determine the prevalence of occult HBV infection and its impact on histological and virological parameters. 52 HIV/HCV (but HBsAg-negative) co-infected patients, 29 HBsAg and anti-HCV negative chronic hepatitis, and 20 HBsAg positive chronic hepatitis controls were studied. DNA was extracted from frozen biopsies and amplified with primers for S, C and X regions, and for (ccc) HBV-DNA. Sera were tested for HBV-DNA with two quantitative assays (Cobas Amplicor HBV Monitor, and the real-time COBAS (r) Taqman HBV Test, Roche Diagnostics, UK). Occult HBV infection was detected in 7 (13.4%) liver biopsies of the study group, and in none case of the non viral chronic hepatitis group (p=0.04). All serum samples were HBV-DNA negative with Cobas Amplicor HBV monitor assay, while 3 cases were found positive with real time PCR. Statistical analysis didn't show any impact of occult HBV infection on liver histology, CD4+ cells count, HIV and HCV load, and ALT levels. Occult B infection is relatively frequent in HIV/HCV co-infected patients, and is underestimated by common HBV-DNA serological assays. However, it doesn't seem to exert a relevant impact.

Clinical impact of occult hepatitis B virus infection in immunosuppressed patients

“…OBI may also be observed in anti-HIV-positive patients with chronic HBV/HCV coinfection, due to an HBsAg serum clearance consequent to a strong inhibitory effect of the HCV genome on HBV replication [103] . In HIV subjects a strong association between OBI and HCV infection has been observed in several studies [28,101,[104][105][106] . In contrast, Jardim et al [107] reported no significant difference in the rate of OBI in HIV-positive patients with or without HCV coinfection.…”

“…Other investigators, however, described no association of OBI with the CD4 count [92] . The prevalence of OBI in HIV-HCV coinfected patients varies in different studies from less than 1% to 40% [22,[93][94][95][96][97][98][99][100][101][102] . OBI may also be observed in anti-HIV-positive patients with chronic HBV/HCV coinfection, due to an HBsAg serum clearance consequent to a strong inhibitory effect of the HCV genome on HBV replication [103] .…”

Occult hepatitis B virus infection in a Cohort of HIV-positive patients: Correlation with hepatitis C virus coinfection, virological and immunological features

“…Several studies [4,5] have investigated the prevalence and the clinical impact of occult HBV infection in HIVinfected persons, though that (1) such individuals are frequently exposed to HCV and HBV because of the common route of transmission [6], (2) chronic hepatitis has a faster progression to cirrhosis and liver decompensation [7,8], and (3) the response to IFN treatment is lower [9]. However, little is known about the genetic characteristics of occult HBV infection, such as HBV infecting genotype and precore stop codon mutant detection in HIV-infected patients.…”

Longitudinal evaluation of occult Hepatitis B infection in HIV-1 infected individuals during highly active antiretroviral treatment interruption and after HAART resumption

“…However, we did not perform intrahepatic quantification of the cccDNA. In a number of studies [3,5,18], the authors did not observe a relationship between absolute CD4? cell count, as a clinical marker of immune status, and the presence of OHB before any anti-HIV treatment or during treatment.…”

“…It is more frequent in patients testing positive for anticore antibodies (anti-HBc) [2]. Several studies [3][4][5] have investigated the prevalence and clinical impact of OHB in human immunodeficiency virus (HIV)-infected individuals, as they are frequently exposed to HBV [6]. Transaminase flares may occur as a result of HBV reactivation in OHB patients following the discontinuation of highly active antiretroviral therapy (HAART) that includes drugs active against HIV/HBV [7,8], while only one study [9] has shown the reactivation of a lamivudine (3TC)-resistant OHB in an HIV-infected individual under cytotoxic chemotherapy.…”