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Liver Enzyme Elevations in HIV Positive Individuals with Occult Hepatitis B Virus Infection

The clinical significance of occult hepatitis B virus (HBV) infection -- that is, the presence of HBV DNA in individuals with HBV core antibodies (anti-HBc) in the absence of HBV surface antigen (HBsAg) -- is unclear in HIV positive patients, and thus it is uncertain whether low-level HBV needs to be detected and treated in this population.

As described in the September 2008 Journal of Clinical Virology, Vincent Lo Re and colleagues from the University of Pennsylvania School of Medicine conducted a study to determine if HIV positive individuals with occult HBV infection have an increased incidence of liver enzyme elevation.

Elevated alanine and aspartate transaminase (ALT and AST, respectively) -- sometimes known as "transaminitis" -- is an indicator of liver inflammation, which may signal hepatitis B or C disease progression, drug-induced liver toxicity, or other liver problems.

This cohort study included 97 randomly selected HIV positive patients in the Penn CFAR Database and Specimen Repository who were HBsAg negative and anti-HBc positive. HBV DNA was qualitatively detected using a transcription-mediated amplification assay. Liver transaminase levels were measured at 6 month intervals from the time of occult HBV determination.


Among the 97 randomly selected participants without elevated transaminase levels at baseline, 13 (13%) had occult HBV.

These patients more frequently had detectable HIV RNA.

The 2-year incidence of elevated liver enzymes among HIV-infected participants with occult HBV was not significantly different from that of patients without occult HBV (50 vs 38 events per 100 person-years, respectively; adjusted incidence rate ratio 1.36).

Based on these findings, the investigators concluded, "Occult HBV did not increase the incidence of hepatic transaminitis over 2 years."

They added that, "Future studies should determine whether occult HBV is associated with other clinically important outcomes, particularly hepatocellular carcinoma."

Division of Infectious Diseases, University of Pennsylvania School of Medicine, Philadelphia, PA; Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA; Center for Education and Research on Therapeutics, University of Pennsylvania School of Medicine, Philadelphia, PA.


V Lo Re, B Wertheimer, AR Localio, and others. Incidence of transaminitis among HIV-infected patients with occult hepatitis B. Journal of Clinical Virology 43(1): 32-36. September 2008. (Abstract).





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