Impact of Occult HBV in HIV Positive Patients
Due to similar transmission routes, many HIV positive individuals are coinfected with the hepatitis B virus (HBV). In most patients, HBV exposure does not lead to chronic disease, but occult or “hidden” virus may persist at low levels.
As reported in the June 12, 2006 issue of AIDS, Italian researchers evaluate the impact of occult HBV in patients with HIV. The study included 115 consecutive antiretroviral-naïve HIV-positive individuals who tested negative for hepatitis B surface antigen (HBsAg). A total of 86 of these patients were followed for at least 6 months (range 6-36 months), with HIV RNA and HBV DNA viral load measured using polymerase chain reaction (PCR) technology.
Results
- Of the 86 patients with follow-up data, plasma HBV DNA was detected in 17 (19.8%); 13 had detectable HBV upon study admission, and 4 during follow-up.
- HBV DNA was more frequently detected in patients with isolated anti-hepatitis B core (HBc) antibodies (35.5% of 31 cases), compared with those lacking anti-HBc and anti-hepatitis B surface (anti-HBs) antibodies (8.8% of 41; P < 0.005), or those showing evidence of both type of antibodies (21.4% of 14).
- 28 patients (32.5%) experienced a hepatic flare during follow-up.
- Hepatitis flares were more frequent among the 17 HBV DNA-positive patients than the 69 HBV DNA negative subjects (64.7% versus 24.6%; P < 0.005).
- Of the 13 HBV DNA-positive patients enrolled, 11 who started HAART containing lamivudine (3TC, Epivir) -- which is active against both HIV and HBV -- became HBV DNA negative.
- However, 2 of these individuals again became HBV DNA-positive and experienced a hepatic flare during treatment, and 2 had this occur both during and after lamivudine therapy.
- Hepatic flares also occurred during lamivudine treatment in 2 of the 4 patients in whom HBV DNA became detectable during follow-up.
Conclusion
In conclusion, the authors wrote, “The study suggests that HBV occult infection, relatively frequent in [HIV positive] patients, is associated with hepatic flares.” They added that the role of immune reconstitution inflammatory syndrome and HAART in inducing hepatic flares was found to be marginal in 49 patients who had no HBV or hepatitis C virus (HCV) markers.
8/15/06
Reference
P Filippini, N Coppola, R Pisapia, and others. Impact of occult hepatitis B virus infection in HIV patients naive for antiretroviral therapy. AIDS. 20(9): 1253-1260. June 12, 2006.
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