Occult hepatitis B in persons infected with HIV is associated with low CD4 counts and resolves during antiretroviral therapy.

Occult hepatitis B virus (HBV) is defined by the presence of plasma HBV DNA in individuals with HBV core antibodies (anti-HBc), but without HBV surface antigen (HBsAg). The prevalence of occult HBV in HIV-infected patients remains controversial, and the risk factors, clinical significance and effect of highly active antiretroviral therapy (HAART) are unknown. The aim of this study was to determine prevalence, risk factors, and clinical significance of occult HBV in HIV-infected patients and to evaluate the effect of HAART. Plasma HBV DNA levels were determined in 191 HIV positive, antiretroviral naïve patients, who were anti-HBc positive and HBsAg negative. Quantitative HBV DNA was determined using a Taqman real-time nested PCR. Additionally, plasma HIV RNA levels, CD4 cell counts, anti-HBs-antibodies, anti-HCV-antibodies, ALT, AST, and gammaGT were determined. Occult HBV (a plasma HBV DNA level >50 copies/ml) was detected in 9/191 (4.7%) of the patients. Among 45 anti-HBs-negative patients (isolated anti-HBc positive), the prevalence was 11.1%. Patients with occult HBV had significantly lower CD4 count compared to anti-HBc-positive/HBsAg negative/HBV DNA-negative patients (105 +/- 157 (median +/- SD) vs. 323 +/- 299 cells/mm(3), P = 0.019). When HAART (including lamivudine) was initiated in the patients with occult HBV, HBV DNA was no longer detectable in any of the patients during 3 years of follow-up. In conclusion, occult HBV was associated with low CD4 counts and may be viewed as opportunistic reactivation of HBV that resolves as a consequence of HAART induced immune reconstitution and/or the effect of lamivudine.

Cohen Stuart JW ，Velema M ，Schuurman R ，Boucher CA ，Hoepelman AI ... -  《-》

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

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.

Nebbia G ，Garcia-Diaz A ，Ayliffe U ，Smith C ，Dervisevic S ，Johnson M ，Gilson R ，Tedder R ，Geretti AM ... -  《JOURNAL OF MEDICAL VIROLOGY》

Impact of occult hepatitis B virus infection in HIV patients naive for antiretroviral therapy.

Filippini P ，Coppola N ，Pisapia R ，Scolastico C ，Marrocco C ，Zaccariello A ，Nacca C ，Sagnelli C ，De Stefano G ，Ferraro T ，De Stefano C ，Sagnelli E ... -  《AIDS》

Occult hepatitis B virus infection in ART-naive HIV-infected patients seen at a tertiary care centre in north India.

Gupta S ，Singh S 《BMC INFECTIOUS DISEASES》

[Investigation of occult hepatitis B in HIV infected patients].

Altınbaş A ，Ergünay K ，Calık Başaran N ，Alp A ，Turgut D ，Hasçelik G ，Uzun Ö ，Unal S ... -  《MIKROBIYOLOJI BULTENI》