Predictors and kinetics of occult hepatitis B virus infection in HIV‐infected persons

Abstract

It has been proposed that occult hepatitis B virus (HBV) infection, defined as detectable HBV-DNA in serum with undetectable surface antigen (HBsAg(-)), is associated with raised transaminases in HIV-infected persons. The aim of this study was to determine the prevalence of occult HBV infection in two independent cohorts, and investigate its predictors, association with alanine-aminotransferase (ALT) levels and response to antiretroviral therapy. Sera from HBsAg(-) persons with core antibody (anti-HBc(+)) were tested by real-time PCR. Overall, 5.2% of patients were HBsAg(+) and 39% HBsAg(-)/anti-HBc(+). The prevalence of occult HBV infection was 48/343 (14.0%; 95% CI 10.7-18.1%), and 27/196 (13.8%) and 21/147 (14.3%) in the two cohorts. Median HBV-DNA load was 342 (51-147,500) and 60 (25-33,850) copies/ml respectively. HBV-DNA detection was associated with absence of surface antibody (anti-HBs), but not with CD4 or ALT levels. Among 11 HBV-DNA(+) persons who started antiretroviral therapy containing lamivudine or lamivudine/tenofovir, HBV-DNA was repeatedly undetectable over median 19 (3-43) months. However, HBV-DNA detection was intermittent among drug-naïve persons. Occult HBV infection is common in HBsAg(-)/anti-HBc(+) HIV-infected patients and predicted by undetectable anti-HBs. The intermittent nature of HBV-DNA detection poses a diagnostic challenge, but no association is observed with ALT levels.

Profile and prevalence of HBV among HIV affected individuals attending the largest public HIV care center in India

“…HBV reactivation and re-infection can also occur and patients who appear to have cleared HBV infection can present with a further episode of acute or chronic hepatitis [12]. The risk of reactivation is higher in patients who are positive for HBcAb but negative for other markers of HBV infection [13]. In the present study, 252 (21.72 %) co-infected individuals showed the presence of 'isolated' core antibody, indicating previous exposure to HBV.…”

Clinical impact of occult hepatitis B virus infection in immunosuppressed patients

“…Some investigators never observed OBI in patients with CD4 counts > 500 cells/μL and concluded for a significant association of OBI with lower CD4 counts [91] . 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] .…”

Occult hepatitis B virus co-infection in HIV-positive patients: A review of prevalence, diagnosis and clinical significance

“…Furthermore, the available data suggest seronegative patients have a different clinical evolution and should therefore be evaluated separately. Another factor that is common in HIV patients and that is known to affect [46] Iran 3 (13.6) 2 (9.1) ND 1 (4.5) Bagaglio et al [47] Italy 9 (31.0) 9 (31.0) ND ND Bell et al [48] Africa [51] Spain 6 (2.4) 2 (0.8) 4 (1.6) ND Filippini et al [13] Italy 17 (20.0) 11 (12.8) 3 (3.5) 3 (3.5) Firnhaber et al [23] Africa 38 (88.4) 38 (88.4) ND ND Gupta et al [30] India 24 (45.3) 13 (24.5) 11 (20.8) ND Hakeem et al [52] Scotland 2 (2.8) 2( 2.9) ND ND Jardim et al [19] Brazil 8 (5.0) 2 (1.3) 6 (3.8) ND Khamduang et al [35] Thailand 47 (23.5) 47 (23.5) ND ND Liang et al [53] Taiwan 3 (2.3) 3 (2.3) ND ND Lo Re et al [54] United States 17 (10.0) 10 (5.6) 7 (3.9) ND Loustaud-Ratti et al [55] France [24] Africa 51 (10.0) 51 (11.8) ND ND Neau et al [58] France 1 (0.6) 1 (0.6) ND ND Nebbia et al [59] England 48 (14.0) 48 (14.0) ND ND Opaleye et al [25] Nigeria 21 (11.2) 8 (4.3) 9 (4.8) 2 (1.1) Panigrahi et al [26] India 12 (10.7) 9 (8.0) 3 (2.7) ND Santos et al [20] Brazil 16 (15.8) 2 4 (4.0) 12 (11.9) ND Sen et al [27] India 1 (5.6) 2 1 (5.6) ND ND Shire et al [60] United States 4 (10.5) 4 (10.5) ND ND Shire et al [61] United States 12 (30.2) 3 (7.0) 5 1 (11.6) 5 (11.6) Sucupira et al [21] Brazil 6 (18.8) 2 3 (9.4) 3 (9.4) ND Torres Barranda et al [22] Mexico 7 (18.4) 1 (2.6) 1 (2.6) 5 (13.2) Tramuto et al [62] Italy 24 (5.9) 8 (2.0) 7 1 (1.7) 9 (2.2) Tsui et al [63] United States 8 (2.0) 8 (2.0) ND ND 1 In some studies the anti-HBsAg positive group was also included; 2 Prevalence calculated using the reported data; anti-HBsAg+, antibodies against hepatitis B surface antigen positive; anti-HBcAg+ antibodies against hepatitis B core antigen positive. Prevalence (%) were included for each group of patients studied according the HBV serological markers (Anti-HBsAg-/anti-HBcAg+, Anti-HBsAg+/anti-HBcAg+, Anti-HBsAg-/anti-HBcAg-).…”