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Occult Hepatitis B Virus in HIV Patients with Low CD4 Cell Counts May Resolve after Starting Antiretroviral Therapy

By Liz Highleyman

Due to overlapping transmission routes, a minority of people with HIV are also coinfected with hepatitis B virus (HBV). In addition to those with measurable hepatitis B surface antigen (HBsAg), some patients have "occult" or hidden HBV, characterized by low-level detectable HBV DNA in individuals with HBV core antibodies (anti-HBc) but without HBsAg.

In a study described in the March 2009 Journal of Medical Virology, James Cohen Stuart and colleagues from University Medical Center Utrecht in the Netherlands assessed the prevalence, risk factors, and clinical significance of occult HBV in HIV positive individuals. They also looked at the effect of highly active antiretroviral therapy (HAART), which could include lamivudine (3TC, Epivir), a drug with dual activity against both HIV and HBV.

The investigators measured plasma HBV DNA levels in 191 initially antiretroviral-naive HIV-infected patients who were anti-HBc positive and HBsAg negative. Quantitative HBV DNA was determined using Taqman real-time nested PCR. HIV RNA levels, CD4 cell counts, anti-HBs antibodies, anti-HCV antibodies, and liver enzyme (ALT, AST, and GGT) levels were also determined.


Occult HBV (HBV DNA > 50 copies/mL) was detected in 9 of the 191 study participants (4.7%).

Among 45 anti-HBs negative but isolated anti-HBc positive patients, the prevalence of occult HBV was 11.1%.

Individuals with occult HBV had significantly lower CD4 counts compared with patients who were anti-HBc positive, HBsAg negative, and HBV DNA negative (105 vs 323 cells/mm3, respectively; P = 0.019).

After initiating HAART (including lamivudine), HBV DNA was no longer detectable in any of the patients with prior occult HBV during 3 years of follow-up.

In conclusion, the investigators wrote, "occult HBV was associated with low CD4 counts and may be viewed as opportunistic reactivation of HBV that resolves as a consequence of HAART induced immune reconstitution and/or the effect of lamivudine."

Department of Virology, Eijkman Winkler Institute for Medical Microbiology, and Infectious Diseases and Inflammation, University Medical Center Utrecht, Utrecht, Netherlands; Department of Internal Medicine & Infectious Diseases, University Medical Center Utrecht, Utrecht, Netherlands.


JW Cohen Stuart, M Velema, R Schuurman, and others. Occult hepatitis B in persons infected with HIV is associated with low CD4 counts and resolves during antiretroviral therapy. Journal of Medical Virology 81(3): 441-445. March 2009. (Abstract).






























FDA-approved Combination Therapies for Chronic HCV Infection
Baraclude  (entecavir)
Epivir-HBV  (lamivudine; 3TC)
Intron A (interferon alfa-2b)

Hepsera (adefovir dipivoxil)
Pegasys (peginterferon alfa-2a)
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