Hepatitis B Serological Markers May Change over Time in HIV-HBV Coinfected Individuals on Antiretroviral Therapy

Evolution of serological markers of hepatitis B virus (HBV) carriage or infection has rarely been investigated among HIV-infected patients receiving HAART, researchers from Taiwan wrote in the November 1, 2007 issue of Clinical Infectious Diseases.

During the 1997-2002 period, the authors tested 633 HIV positive patients for HBV serological markers at baseline, including hepatitis B surface antigen (HBsAg), antibody to HBsAg (anti-HBs), antibody to hepatitis B core antigen (anti-HBc), hepatitis C virus (HCV) antibody (anti-HCV), HCV RNA level, and HBV DNA level. All markers were retested at least 1 year apart. Medical records were reviewed to identify clinical characteristics associated with evolution of these serological markers.

Results

·         After a median follow-up period of just under 5 years, 161 patients (25.4%) had changes in their HBV serological markers.

·         Of 119 patients (18.8%) who tested positive for HBsAg at baseline, 6 (5.0%) developed anti-HBs, and 9 (7.6%) developed isolated anti-HBc.

·         Of 270 patients (42.7%) who tested positive for anti-HBs, 18 (6.7%) lost anti-HBs.

·         Of 179 patients (28.3%) in whom isolated anti-HBc had been detected, 73 (40.8%) developed anti-HBs, 18 (10.1%) lost all HBV markers, and 7 (3.9%) developed HBsAg.

·         Of 65 patients (10.2%) who tested negative for all HBV markers, 13 (20%) developed anti-HBs, 13 (20%) developed isolated anti-HBc, and 4 (6.2%) developed HBsAg, indicating a high risk of HBV exposure.

·         Patients in whom anti-HBc was detected at baseline were more likely to have acquired immunodeficiency syndrome (P = 0.008).

·         Multivariate analysis revealed that an increase in CD4 cell count after starting HAART was significantly associated with persistence or subsequent development of anti-HBs in patients with anti-HBs or anti-HBc at baseline, respectively.

Conclusion

Based on these findings, the authors wrote, “Periodic measurements of HBV serological markers in HIV-infected patients are recommended, because new HBV infections and changes of HBV serological markers are not uncommon in patients with improved immunity after commencement of HAART.”

10/19/07

Reference
WH Sheng, JH Kao, PJ Chen, and others. Evolution of hepatitis B serological markers in HIV-infected patients receiving highly active antiretroviral therapy. Clinical Infectious Diseases 45(9): 1221-1229. November 1, 2007.