Occult Hepatitis B Virus Infection before and 1 Year after Start of HAART in HIV Type 1-Positive Patients

Abstract

Occult hepatitis B virus (HBV) infection is diagnosed when HBc antibodies and HBV-DNA are detectable in serum while hepatitis B surface antigen (HBsAg) is not. The clinical relevance of this phenomenon in HIV-1 patients starting highly active antiretroviral therapy (HAART) is unknown. We followed 93 therapy naive HIV-1-infected adults who were anti-HBc positive, HBsAg and HBeAg negative, during first year of HAART. At baseline, HBV-DNA was quantified, and HBV genotype was determined in the HBV-DNA-positive patients by sequencing a part of the HBV genome. Four of 93 patients (4%) were HBV DNA positive at baseline. All four patients tested negative for HBV-DNA after 1 year. They all received lamivudine as part of their HAART. They had no clinically significant liver enzyme elevations (LEE) during the first year of HAART. Two of the patients had a genotype A, one genotype E, and in the fourth patient sequencing was not possible. In one patient we found significant mutations in the a determinant region of HBsAg, at positions 142 and 144. In our population of therapy-naive HIV-1-infected adults who were anti-HBc positive, we found occult HBV infection in 4% of the patients. We did not find an increased risk for LEE in our population of patients after the start of HAART. Our results illustrate that occult HBV infection is more a diagnostic than a clinical problem. It may be caused by very low levels of HBV replication, concurrent presence of HBsAg and anti-HBs, or mutations in the HBsAg a determinant.

Clinical significance of "anti-HBc alone" in human immunodeficiency virus-positive patients

“…More than 90% of doctors that attend HIV patients follow this practice [22] . However, the latest recommendations in HIV-positive patients with the "anti-HBc alone" pattern advise to test for HBV DNA in every patient [6,10,12,13,20] . We believe that HBV DNA testing should be performed only in those patients with an unexplained high level of alanine aminotransferase (ALT) or signs of liver disease.…”

“…HBV DNA positive markers without HBV surface antigen (HBsAg), among patient with a defective immunological response. Some authors consider the "anti-HBc alone" pattern to be a marker of occult HBV infection [1,3,8,9] , whereas others have not been able to demonstrate HBV DNA in the sera of these patients [10][11][12][13] . This work was carried out to establish the prevalence and clinical significance of the "anti-HBc alone" pattern among HIV-positive patients.…”

Clinical impact of occult hepatitis B virus infection in immunosuppressed patients

“…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] .…”

Immune Restoration Diseases Reflect Diverse Immunopathological Mechanisms

“…LEE can follow initiation of ART in the setting of occult HBV infection (HBsAg negative and HBV DNA positive). This may represent an IRD (47,109).…”