Hepatitis B Virus in HIV Patients with Low CD4 Cell Counts May Resolve after Starting
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
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.
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
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.
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."
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.
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).