HIV and Hepatitis.com Coverage of the
13th Annual Conference on Retroviruses and Opportunistic Infections
February 5 - 8, 2006, Denver, CO

How Common Is Occult HBV Infection in HIV Coinfected Patients? 

By Marina Nunez, MD, PhD

Occult HBV infection is defined by presence of low HBV DNA levels in plasma in the absence of HBs antigen. Disparate figures of prevalence have been given in HIV/HBV coinfected patients, and the clinical relevance of the phenomenon  remains unclear.

US researchers evaluated the presence of occult HBV infection among 967 HIV-infected patients. Samples were randomly selected from a database including 3,867 HIV+ subjects with serum stored between 1988 and 2004. Fifty eight known HBV+ patients were excluded from test pools. Real-time PCR was used to co-amplify regions of HBV core and surface. HBV DNA-positive samples were tested for HBs antigen and for anti-HBs and anti-HBc antibodies.

HBV DNA was positive in 44 individual samples (4.5%), 12 in the absence of HBsAg and 32 with concomitant HBsAg (see table). Thus, occult HBV infection was present in 1.2% in this HIV population.

Serologic markers of patients with positive HBV DNA by real-time PCR:

 

Anti-HBc+

Anti-HBs+

Anti-HBc+

Anti-HBs-

Anti-HBc-

Anti-HBs+

Anti-HBc-

Anti-HBs-

Total

HBsAg+

n = 4

n = 17

n = 5

n = 6

N = 32

HBsAg-

n = 4

n = 2

n = 1

n = 5

N = 12

Transaminase levels were tested well. As the figure shows, ALT and AST were higher in the HBsAg+ group than in the other two (p < 0.001) but the occult HBV group was comparable to the HBV-negative group (p > 0.05). One patient with occult HBV and ALT > 2x ULN was coinfected with HCV.

ALT and AST by HBV Status

ALT and AST were higher in HBsAg+ group than in other two (p < 0.001) but occult group was comparable to HBV-negative group (p > 0.05). One occult patient with ALT > 2x ULN was HCV coinfected.

In conclusion, occult HBV was very infrequent (1.24%) in this HIV cohort. The serological patterns of patients with occult HBV infection were diverse. The authors highlighted that ‘nearly 50% of those with HBV were not identified as HBV-infected previously, indicating a need for continued screening in those who are unvaccinated or fail to respond to vaccine’. Regarding clinical consequences, in this cross-sectional analysis there was no evidence of liver injury due to occult HBV. However, unrecognized HBV infection may have implications for choice of antiretroviral therapy. A longitudinal prospective analysis is planned by the research team.

2/21/06

Reference
N Shire and others. Occult hepatitis B virus in an HIV-infected cohort. 13th Conference on Retroviruses and Opportunistic Infections. 5-8 February 2006, Denver, CO [Abstract 835].