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HIV-HCV Coinfected Individuals in Italy Are Likely to also Have Occult HBV

Among HIV positive participants in the Italian ICONA cohort, 15% had detectable hepatitis B virus (HBV), and this was almost 3 times more common among patients who were also infected with hepatitis C virus (HCV), according to a study published in the advance online edition of the journal Infection.

By Liz Highleyman

Evaluating the prevalence of occult HBV infection in HIV positive individuals is important because even low levels of HBV may contribute to liver disease progression, potentially leading to higher rates of cirrhosis, hepatocellular carcinoma, and end-stage liver failure.

Investigators with the ICONA (Italian Cohort Naive Antiretroviral) study evaluated 175 participants (11% of the total cohort of 1593 HIV positive patients) selected because they were hepatitis B surface antigen (HBsAg) negative but hepatitis B core antigen (anti-HBc) positive, a sign of "occult," or hidden, HBV infection. More than half (58%) of this group also had antibodies against HCV.

About one-third of study participants (31.4%) were antiretroviral treatment-naive and had not received prior antiretroviral therapy (ART), 27.2% were receiving ART without lamivudine (3TC; Epivir) or tenofovir (Viread, also in the Truvada and Atripla combination pills) -- agents with dual activity against both HIV and HBV -- and the remaining 41.4% were receiving ART regimens containing these 2 drugs.

HBV DNA (viral genetic material) was measured in blood plasma using a highly sensitive PCR assay with a limit of detection of 2.6 copies/mL, and 2 different regions of the viral genome were assessed.

Results

27 study participants, or 15%, had detectable plasma HBV DNA.
Among these patients, 21 out of 101 (21%) were HCV antibody positive and 6 out of 74 (8%) were HCV antibody negative.
Therefore, the rate of occult HBV infection was significantly higher among HIV-HCV coinfected patients (adjusted odds ratio [OR] 5.02; P = 0.02).
The likelihood of occult HBV did not differ according to immune status, HIV viral load, or specific ART regimen.
In the 20 cases analyzed, all patients had HBV genotype D.

Based on these findings, the researcher concluded, "In relation to the high prevalence of occult HBV infection, particularly in HIV-HCV-coinfected individuals, it is necessary to clarify the clinical impact of this cryptic infection by monitoring HBV DNA in plasma."

S. Raffaele Scientific Institute, Milan, Italy; University of Ancona, Ancona, Italy; S. Paolo Hospital, University of Milan, Milan, Italy; Royal Free and University College Medical School, London, UK; National Institute of Infectious Diseases "L. Spallanzani," Rome, Italy; University of Pavia, Pavia, Italy; University of Bari, Bari, Italy; Centro di Riferimento AIDS, Latina, Italy; University of Perugia, Perugia, Italy; E.O. Ospedale Galliera, Genoa, Italy; S. Anna Hospital, Como, Italy.

8/21/09

Reference
G Morsica, F Ancarani, S Bagaglio, and others (for the HepaICONA and ICONA Study Groups). Occult Hepatitis B Virus Infection in a Cohort of HIV-Positive Patients: Correlation with Hepatitis C Virus Coinfection, Virological and Immunological Features. Infection. August 9, 2009 [Epub ahead of print]. (Abstract).