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Craviotto V, Furfaro F, Loy L, Zilli A, Peyrin-Biroulet L, Fiorino G, Danese S, Allocca M. Viral infections in inflammatory bowel disease: Tips and tricks for correct management. World J Gastroenterol 2021; 27:4276-4297. [PMID: 34366605 PMCID: PMC8316900 DOI: 10.3748/wjg.v27.i27.4276] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/01/2021] [Accepted: 05/15/2021] [Indexed: 02/06/2023] Open
Abstract
Over the past decades, the treatment of inflammatory bowel diseases (IBD) has become more targeted, anticipating the use of immune-modifying therapies at an earlier stage. This top-down approach has been correlated with favorable short and long-term outcomes, but it has also brought with it concerns regarding potential infectious complications. This large IBD population treated with immune-modifying therapies, especially if combined, has an increased risk of severe infections, including opportunistic infections that are sustained by viral, bacterial, parasitic, and fungal agents. Viral infections have emerged as a focal safety concern in patients with IBD, representing a challenge for the clinician: they are often difficult to diagnose and are associated with significant morbidity and mortality. The first step is to improve effective preventive strategies, such as applying vaccination protocols, adopt adequate prophylaxis and educate patients about potential risk factors. Since viral infections in immunosuppressed patients may present atypical signs and symptoms, the challenges for the gastroenterologist are to suspect, recognize and diagnose such complications. Appropriate treatment of common viral infections allows us to minimize their impact on disease outcomes and patients’ lives. This practical review supports this standard of care to improve knowledge in this subject area.
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Affiliation(s)
- Vincenzo Craviotto
- Humanitas Clinical and Research Center, IRCCS, Rozzano 20089, Milano, Italy
| | - Federica Furfaro
- Humanitas Clinical and Research Center, IRCCS, Rozzano 20089, Milano, Italy
| | - Laura Loy
- Humanitas Clinical and Research Center, IRCCS, Rozzano 20089, Milano, Italy
| | - Alessandra Zilli
- Humanitas Clinical and Research Center, IRCCS, Rozzano 20089, Milano, Italy
| | - Laurent Peyrin-Biroulet
- Department of Hepato-Gastroenterology and Inserm U954, University Hospital of Nancy, Lorraine University, Nancy 54511, France
| | - Gionata Fiorino
- Humanitas Clinical and Research Center, IRCCS, Rozzano 20089, Milano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele 20090, Milano, Italy
| | - Silvio Danese
- Humanitas Clinical and Research Center, IRCCS, Rozzano 20089, Milano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele 20090, Milano, Italy
| | - Mariangela Allocca
- Humanitas Clinical and Research Center, IRCCS, Rozzano 20089, Milano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele 20090, Milano, Italy
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Ayana DA, Mulu A, Mihret A, Seyoum B, Aseffa A, Howe R. Occult Hepatitis B virus infection among HIV negative and positive isolated anti-HBc individuals in eastern Ethiopia. Sci Rep 2020; 10:22182. [PMID: 33335238 PMCID: PMC7747707 DOI: 10.1038/s41598-020-79392-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 12/02/2020] [Indexed: 01/05/2023] Open
Abstract
The absence of hepatitis B surface antigen (HBsAg) and the presence of antibody to hepatitis B core antigen (anti-HBc) in the blood of apparently healthy individuals may not indicate the absence of circulating hepatitis B virus (HBV) and might be infectious. Despite the risk of HBV transmission, there has been no report from Ethiopia examining this issue; therefore, this study determined occult HBV infection (OBI) among isolated anti-HBc (IAHBc) HIV negative and HIV positive individuals on ART in eastern Ethiopia. A total of 306 IAHBc individuals were included in this study. DNA was extracted, amplified, and detected from plasma using a commercially available RealTime PCR platform (Abbott m2000rt) following the manufacturer's instructions. Data were entered into EPI Data version 3.1, cleaned, and analyzed using Stata version 13. Descriptive analysis was used to calculate prevalence, summarize sociodemographic data and other factors. From the 306 IAHBc individuals (184 HIV positive and 122 HIV negative) included in the study, 183 (59.8%) were female of which 142 (77.6%) were within the reproductive age group. DNA extraction, amplified and detection was conducted in 224 individuals. The overall OBI prevalence was 5.8% (5.6% in HIV negative and 6% in HIV positive) among the IAHBc individuals. The HBV DNA concentration among the occult hepatitis B individuals was < 200 IU/mL, indicating a true occult. This study reported the burden of OBI, which pauses a significant public health problem due to the high burden of HBV infection in the country. OBI may cause substantial risk of HBV transmission from blood transfusion, organ transplantation as well as vertical transmission as screening is solely dependent on HBsAg testing.
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Affiliation(s)
- Desalegn Admassu Ayana
- College of Health and Medical Sciences, Haramaya University, Haramaya, Ethiopia.
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia.
| | - A Mulu
- College of Health and Medical Sciences, Haramaya University, Haramaya, Ethiopia
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - A Mihret
- College of Health and Medical Sciences, Haramaya University, Haramaya, Ethiopia
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - B Seyoum
- College of Health and Medical Sciences, Haramaya University, Haramaya, Ethiopia
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - A Aseffa
- College of Health and Medical Sciences, Haramaya University, Haramaya, Ethiopia
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - R Howe
- College of Health and Medical Sciences, Haramaya University, Haramaya, Ethiopia
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
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Dehghani-Dehej F, Hosseini Z, Mortazkar P, Khanaliha K, Esghaei M, Fakhim A, Bokharaei-Salim F. Prevalence of HCV and/or HBV coinfection in Iranian HIV-infected patients. Future Virol 2020. [PMCID: PMC7273902 DOI: 10.2217/fvl-2019-0066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Aim: HIV-infected patients risk coinfection with HBV and HCV. This study aimed to investigate molecular epidemiology of HBV and HCV coinfection in Iranian HIV-infected individuals. Materials & methods: In this cross-sectional study, serological markers of HBV and HCV infection (hepatitis B surface antigen [HBsAg], hepatitis B e-antigen [HBeAg], hepatitis B e-antibody [HBeAb] and hepatitis B core antibody [HBcAb]) and anti-HCV antibodies [anti-HCV Abs] were tested in 198 Iranian HIV-infected patients. From plasma, HBV viral load was determined using COBAS TaqMan 48, and HCV-RNA was detected by reverse transcriptase-nested PCR. Results: 85 out of 198 (42.9%) patients were anti-HCV Ab positive and 42/198 (21.2%) had detectable HCV-RNA. Eight (4.0%) had traceable HBV-DNA. All these patients were infected by HBV genotype D. 55 (27.8%) were HBcAb positive. Nine (4.4%) were HBsAg and anti-HCV Ab positive. Conclusion: None were HIV-RNA/HCV-RNA/HBV-DNA positive, 21.2% were HIV-RNA/HCV-RNA positive and 4.0% were HIV-RNA/HBV-DNA positive. Therefore, studies on diagnosing these infections in HIV-infected individuals may be valuable.
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Affiliation(s)
- Farzaneh Dehghani-Dehej
- Department of Virology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Master of Science of Virology, Iran University of Medical Sciences, Tehran, Iran
| | - Zinat Hosseini
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- General Medical Student, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Poupak Mortazkar
- Department of Virology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- PhD Student of Virology, Department of Virology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Khadijeh Khanaliha
- Research Center of Pediatric Infectious Diseases, Institute of Immunology & Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran
- Assistant Professor of Parasitology, Research Center of Pediatric Infectious Diseases, Institute of Immunology & Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Esghaei
- Department of Virology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Associate Professor of Virology, Iran University of Medical Sciences, Tehran, Iran
| | - Atousa Fakhim
- Department of Architectural Engineering, Faculty of Engineering, Islamic Azad University, South Tehran Branch, Tehran, Iran
- Student of Architectural Engineering, Islamic Azad University, South Tehran Branch, Tehran, Iran
| | - Farah Bokharaei-Salim
- Department of Virology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Assistant Professor of Virology, Iran University of Medical Sciences, Tehran, Iran
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Silva CMD, Peder LDD, Thomazella MV, Teixeira JJV, Bertolini DA. PROFILE OF HCV GENOTYPES AND HIV-SUBTYPES AMONG HIV-COINFECTED PATIENTS IN SOUTHERN BRAZIL. ARQUIVOS DE GASTROENTEROLOGIA 2020; 56:344-350. [PMID: 31800733 DOI: 10.1590/s0004-2803.201900000-68] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 09/07/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Hepatitis B and C virus (HBV and HCV) are the two most common infections among human immunodeficiency virus (HIV)-infected patients. OBJECTIVE To identify the frequency of HIV subtypes and HCV genotypes in HIV-coinfected patients. METHODS A cross-sectional and retrospective study was carried out into two reference centers in Southern Brazil between January 1, 2002 and June 30, 2016. The Abbott Real Time HCV Genotype II system was used for routine diagnostics to determine the HCV genotype based on dual-target real-time PCR. Proviral HIV-1 RNA was extracted from serum samples and fragments of the pol gene were generated by PCR. The HIV-1 PT and RT gene sequences were submitted to Maximum Likelihood Phylogenetic analysis by collecting reference sequences from the HIV-1 group M subtype of the Los Alamos database. RESULTS During the study period, 3340 patients with HIV were diagnosed at both referral centers, of which 4.97% (166/3340) had HBV and/or HCV coinfection. Seroprevalence of HIV-HBV, HIV-HCV and HIV-HBV-HCV was 37.4%, 58.4%, and 4.2%, respectively. HIV-HCV-coinfected patients had a lower median nadir CD4+ T-cell count when compared to HIV-HBV-coinfected patients (P=0.01). Among those coinfected with HCV, HCV-1 (HCV-1) and HCV-3 (HCV-3) genotypes were the most prevalent, being detected in 73.8% and 21.4%, respectively. Among the HCV-1 coinfected patients, 79.3% and 20.1% had subtypes 1a and 1b, respectively. HIV subtype B was the most prevalent in HIV-coinfected patients. There was no significant difference regarding nadir CD4+ T-cell count and HIV viral load when compared to coinfected with HCV-1 with HCV-3, as well as those co-infected with HCV-1a with HCV-1b. CONCLUSION In the present study, a higher frequency of subtype B of HIV and HCV-1 were found in HIV-coinfected patients. Further larger-scale and long-term studies are needed to better understand the effect of HCV genotypes in HIV-infected patients.
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Affiliation(s)
| | - Leyde Daiane de Peder
- Universidade Estadual de Maringá, Departamento de Análises Clínicas e Biomedicina, Maringá, PR, Brasil
| | - Mateus Vailant Thomazella
- Universidade Estadual de Maringá, Departamento de Análises Clínicas e Biomedicina, Maringá, PR, Brasil
| | | | - Dennis Armando Bertolini
- Universidade Estadual de Maringá, Departamento de Análises Clínicas e Biomedicina, Maringá, PR, Brasil
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Farshidpour M, Charabaty A, Mattar MC. Improving immunization strategies in patients with inflammatory bowel disease. Ann Gastroenterol 2019; 32:247-256. [PMID: 31040621 PMCID: PMC6479655 DOI: 10.20524/aog.2019.0351] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 11/11/2018] [Indexed: 02/06/2023] Open
Abstract
Patients with inflammatory bowel disease (IBD) are susceptible to varieties of opportunistic infections due to immunological changes in the setting of their disease and drug-induced immunosuppression. Even though numerous infections can be prevented by vaccine, vaccination in IBD patients is inadequate. Data showed only 9% were vaccinated against pneumococcal infection and 28% described commonly receiving influenza vaccine. This review article discusses the recent immunizations against influenza virus; pneumococcal infection; human papilloma virus; tetanus, diphtheria and pertussis; measles, mumps and rubella; varicella zoster; and herpes zoster for individuals diagnosed with IBD and those patients with drug-related immunosuppression. In addition, this review discusses concerns about IBD patients planning to travel abroad. Immunization status and screening for opportunistic infection need to be addressed in IBD patients at the time of diagnosis and they should be vaccinated accordingly. Generally, standard vaccination strategies should be pursued in IBD patients, although live vaccines should be avoided while they are not immunocompetent.
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Affiliation(s)
- Maham Farshidpour
- Department of Inpatient Medicine, Banner University Medical Center, University of Arizona, Tucson (Maham Farshidpour), USA
| | - Aline Charabaty
- Division of Gastroenterology, MedStar Georgetown University Hospital, Washington, DC, USA (Aline Charabaty, Mark C. Mattar), USA
| | - Mark C Mattar
- Division of Gastroenterology, MedStar Georgetown University Hospital, Washington, DC, USA (Aline Charabaty, Mark C. Mattar), USA
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da Silva CM, de Peder LD, Guelere AM, Horvath JD, Silva ES, Teixeira JJV, Bertolini DA. Seroprevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) among human immunodeficiency virus (HIV)-infected patients in an HBV endemic area in Brazil. PLoS One 2018; 13:e0203272. [PMID: 30192795 PMCID: PMC6128547 DOI: 10.1371/journal.pone.0203272] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 08/17/2018] [Indexed: 01/03/2023] Open
Abstract
Background Hepatitis B virus (HBV) and hepatitis C virus (HCV) are a common cause of complications in liver disease and immunological impairment among human immunodeficiency virus (HIV)-infected patients. The aim of this study was to assess the seroprevalence of HBV and HCV and their correlation with CD4+ T-cells among HIV-infected patients in an HBV endemic area. Methods A cross-sectional observational and retrospective study was carried out in a reference center in Southern Brazil between January 2005 and December 2016. Socio-demographic data were collected by using a structured questionnaire. Serological tests and analysis of CD4+ T-cell count levels were performed using standard procedures. Results The seroprevalence of HIV-HBV, HIV-HCV, and HIV-HBV-HCV coinfections was 3.10%, 3.10%, and 0.16%, respectively. At baseline, anti-hepatitis B surface and anti-hepatitis B core antigens were detected in 46.27% and 16.74% of HIV-monoinfected patients and in 31.25% and 21.86% of the HIV-HCV coinfected patients, respectively. The median CD4+ T-cell count at baseline in the HIV-monoinfected group was higher than that in the HIV-coinfected groups, but without statistical significance. The median CD4+ T-cell count and the CD4/CD8 ratio were significantly higher in HIV-HBV and HIV-HCV groups after 24 months of combination antiretroviral therapy (cART) compared to the pre-cART values. When comparing patients with HIV-HBV and HIV-HCV on cART, CD4+ T-cell recovery was more rapid for HIV-HBV patients. Conclusion Although the analyzed region was endemic for HBV, the prevalence of HIV-HBV and HIV-HCV coinfection was lower than the rate found in the general population of Brazil. HBV and HCV had no significant impact on CD4+ T-cell counts among HIV-infected patients at baseline.
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Affiliation(s)
| | - Leyde Daiane de Peder
- Post-graduate Program in Bioscience and Physiopathology, Maringá State University, Maringá, Paraná, Brazil
| | | | | | | | | | - Dennis Armando Bertolini
- Department of Clinical Analysis and Biomedicine, Maringá State University, Maringá, Paraná, Brazil
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Kim MH, Kang SY, Lee WI. Occult HBV among Anti-HBc Alone: Mutation Analysis of an HBV Surface Gene and Pre-S Gene. Yonsei Med J 2017; 58:557-563. [PMID: 28332361 PMCID: PMC5368141 DOI: 10.3349/ymj.2017.58.3.557] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 12/23/2016] [Accepted: 01/26/2017] [Indexed: 12/14/2022] Open
Abstract
PURPOSE The aim of this study is to investigate the molecular characteristics of occult hepatitis B virus (HBV) infection in 'anti-HBc alone' subjects. MATERIALS AND METHODS Twenty-four patients with 'anti-HBc alone' and 20 control patients diagnosed with HBV were analyzed regarding S and pre-S gene mutations. All specimens were analyzed for HBs Ag, anti-HBc, and anti-HBs. For specimens with an anti-HBc alone, quantitative analysis of HBV DNA, as well as sequencing and mutation analysis of S and pre-S genes, were performed. RESULTS A total 24 were analyzed for the S gene, and 14 were analyzed for the pre-S gene through sequencing. A total of 20 control patients were analyzed for S and pre-S gene simultaneously. Nineteen point mutations of the major hydrophilic region were found in six of 24 patients. Among them, three mutations, S114T, P127S/T, M133T, were detected in common. Only one mutation was found in five subjects of the control group; this mutation was not found in the occult HBV infection group, however. Pre-S mutations were detected in 10 patients, and mutations of site aa58-aa100 were detected in 9 patients. A mutation on D114E was simultaneously detected. Although five mutations from the control group were found at the same location (aa58-aa100), no mutations of occult HBV infection were detected. CONCLUSION The prevalence of occult HBV infection is not low among 'anti-HBc alone' subjects. Variable mutations in the S gene and pre-S gene were associated with the occurrence of occult HBV infection. Further larger scale studies are required to determine the significance of newly detected mutations.
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Affiliation(s)
- Myeong Hee Kim
- Department of Laboratory Medicine, Kyung Hee University School of Medicine and Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - So Young Kang
- Department of Laboratory Medicine, Kyung Hee University School of Medicine and Kyung Hee University Hospital at Gangdong, Seoul, Korea.
| | - Woo In Lee
- Department of Laboratory Medicine, Kyung Hee University School of Medicine and Kyung Hee University Hospital at Gangdong, Seoul, Korea
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Puri P, Sharma P, Lolusare A, Sashindran V, Shrivastava S, Nagpal A. Liver Function Tests Abnormalities and Hepatitis B Virus & Hepatitis C Virus Co-infection in Human Immunodeficiency Virus (HIV)-infected Patients in India. J Clin Exp Hepatol 2017; 7:1-8. [PMID: 28348464 PMCID: PMC5357744 DOI: 10.1016/j.jceh.2016.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 12/22/2016] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND While highly active anti-retroviral therapy (HAART) has improved survival of HIV-infected patients, there is increasing liver disease and progressive Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) related liver disease. AIMS To study the liver function tests (LFT) and HBV and HCV co-infection in HIV-infected patients. MATERIAL AND METHODS All HIV-positive patients presenting to a tertiary level hospital from April 2009 to April 2011 were evaluated. Baseline LFT, CD4/CD8 counts, ultrasound abdomen, HBsAg, IgG anti-HBc, HBVDNA, Anti-HCV and HCVRNA were done in all patients. LFT was repeated monthly or more frequently with anti-tubercular therapy (ATT)/HAART. RESULTS Abnormal LFT were seen in 143/320 (44.6%) HIV-infected patients (n = 320; M-282, F-38; mean age-35.4 ± 7.3 years). Baseline LFT was abnormal in 48 (15%) [hepatotropic viruses-19, alcohol-24, NAFLD-1, disseminated TB-1, idiopathic-03). Subsequent LFT derangement developed in 95/272 (34.9%). In the majority, the LFT abnormality was mild (119/143-83.2%) and multi-factorial [HAART 132 (76.4%), alcohol 69 (48.2%), ATT 31 (21.7%), HBV 16 (11.2%), HCV 15 (10.4%)]. Using multivariate analysis, abnormal LFT were associated with HAART (OR, 5.92; 95%CI, 2.83-12.37), ATT (OR, 2.06; 95%CI, 1.06-3.99) or HCV infection (OR, 2.54; 95%CI, 1.03-6.26). Significant hepatotoxicity requiring drug modification was seen in only 7 cases. HBV, HCV and HBV + HCV co-infection were seen in 37 (11.6%), 28 (8.8%) and 2 (0.6%) respectively. Occult co-infections were rare [HBV-1 (0.3%); HCV-3 (0.9%)]. CONCLUSION While LFT abnormalities in HIV are common, they are usually mild and multifactorial. HBV and HCV co-infections were seen in 11.6% and 8.8%, respectively. Occult HBV and HCV infections were rare.
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Affiliation(s)
- P. Puri
- Department of Internal Medicine, Armed Forces Medical College, Pune 411040, India,Address for correspondence: Brig Pankaj Puri, Department of Internal Medicine, Armed Forces Medical College, Sholapur Road, Pune 411040, India.
| | - P.K. Sharma
- Department of Internal Medicine, Armed Forces Medical College, Pune 411040, India
| | - A. Lolusare
- Department of Gastroenterology, Army Hospital (R&R), New Delhi 110010, India
| | - V.K. Sashindran
- Department of Internal Medicine, Armed Forces Medical College, Pune 411040, India
| | - S. Shrivastava
- Department of Gastroenterology, Command Hospital, Udhampur, India
| | - A.K. Nagpal
- Department of Internal Medicine, Armed Forces Medical College, Pune 411040, India
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9
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Pathania S, Kaur N, Kumar S, Sashindran VK, Puri P. A cross-sectional study of liver function tests in HIV-infected persons in Western India. Med J Armed Forces India 2017; 73:23-28. [PMID: 28123241 DOI: 10.1016/j.mjafi.2016.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 12/05/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Derangement of liver function tests (LFTs) is common in people living with human immunodeficiency virus/acquired immune deficiency syndrome (PLHA). The cause is multifactorial. Drug-induced liver injury (DILI) is the commonest cause and others being alcohol abuse and concomitant viral hepatitis. The aim of the research was to study the prevalence of LFT abnormalities in PLHA. METHODS The study was carried out in a tertiary care hospital. Evaluation included a detailed history, thorough clinical examination and investigations including a haemogram, serum biochemistry, serology for hepatitis, and CD4 cell count. RESULTS A total of 247 patients were evaluated. Of these, 212 (85.82%) were on antiretroviral therapy (ART), 111 (44.93%) were on anti-tubercular therapy (ATT), and 94 (38.05%) were on concurrent ATT-ART. Abnormal LFTs were seen in 128/247 (51.82%) PLHA. In the majority (88.28%), the LFT abnormalities were mild. LFT abnormalities were seen in 109/212 (51.4%) patients on ART, in 56/111 (50.5%) patients on ATT, 46/94 (48.93%) patients on concurrent ART-ATT. There was no difference in LFT abnormalities among the three groups nor was there any significant association with alcohol consumption. There was a statistically significant co-relation between albumin/globulin ratio and CD4 count (p = 0.0002). Counter-intuitively, LFT abnormalities were commoner in patients not receiving nevirapine (p = 0.043), but severe abnormalities (grade III/grade IV) were commoner in those receiving nevirapine (p = 0.005) and in those on concurrent ART-ATT (p = 0.008). CONCLUSION LFT abnormalities in PLHA are common; but usually mild. There is a strong association between severe abnormalities and nevirapine-based therapy (p = 0.02) and concurrent ATT-ART (p = 0.008).
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Affiliation(s)
- Sunny Pathania
- Resident, Department of Medicine, Armed Forces Medical College, Pune 411040, India
| | - Navjyot Kaur
- Assistant Professor (Medicine), Command Hospital (Southern Command), Pune 411040, India
| | - Sandeep Kumar
- Assistant Professor, Department of Medicine, Armed Forces Medical College, Pune 411040, India
| | - V K Sashindran
- Professor & Head, Department of Geriatric Medicine, Armed Forces Medical College, Pune 411040, India
| | - Pankaj Puri
- Professor & Head, Department of Internal Medicine, Armed Forces Medical College, Pune 411040, India
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10
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Molecular Detection and Characterization of Hepatitis B Virus. Mol Microbiol 2016. [DOI: 10.1128/9781555819071.ch32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Vargas JI, Jensen D, Sarmiento V, Peirano F, Acuña P, Fuster F, Soto S, Ahumada R, Huilcaman M, Bruna M, Jensen W, Fuster F. Presence of anti-HBc is associated to high rates of HBV resolved infection and low threshold for Occult HBV Infection in HIV patients with negative HBsAg in Chile. J Med Virol 2015; 88:639-46. [PMID: 26381185 DOI: 10.1002/jmv.24384] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2015] [Indexed: 12/30/2022]
Abstract
HBV-HIV coinfection is prevalent. Frequently, anti-HBc is the only serological marker of HBV, which can be indicative of HBV resolved infection, when found together with anti-HBs reactivity; or present as "isolated anti-HBc," related to HBV occult infection with presence of detectable DNA HBV, more prevalent in HIV-positive individuals. Regional data about this condition are scarce. Anti-HBc rapid test has been used as screening, but its performance has not been described in HIV-positive patients. The aim of this study was determine prevalence of anti-HBc in HIV-positive patients, serological pattern of HBV resolved infection and isolated anti-HBc, evaluating presence of HBV occult infection. Assess anti-HBc rapid test compared to ECLIA. Methods included measurement of anti-HBc and anti-HBs in HIV-positive patients with negative HBsAg. Serum HBV DNA quantification and HBV booster vaccination to "isolated anti-HBc" individuals. Detection of anti-HBc by rapid test and ECLIA. In 192 patients, prevalence of anti-HBc was 42.7% (82/192); associated to male gender, drug use, men-sex-men, positive-VDRL, and longer time HIV diagnosis. 34.4% (66/192) had presence of anti-HBs, mean titers of 637 ui/ml. Isolated anti-HBc in 8.3% (16/192), associated to detectable HIV viral load and no-use of HAART; in them, HBV DNA was undetectable, and 60% responded to HBV vaccination booster. Anti-HBc rapid test showed low sensibility (32.9%) compared to ECLIA. These results show that prevalence of anti-HBc in HIV-positive individuals is high, in most cases accompanied with anti-HBs as HBV resolved infection. Low prevalence of "isolated anti-HBc," with undetectable HBV DNA, and most had anamnestic response to HBV vaccination; suggest low possibility of occult HBV infection. Anti-HBc rapid test cannot be recommended as screening method for anti-HBc.
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Affiliation(s)
- Jose Ignacio Vargas
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.,Servicio de Medicina Interna, Hospital Naval Almirante Nef, Viña del Mar, Chile
| | - Daniela Jensen
- Servicio de Medicina Interna, Hospital Naval Almirante Nef, Viña del Mar, Chile.,Escuela de Medicina, Universidad de Valparaíso, Valparaíso, Chile
| | - Valeska Sarmiento
- Unidad de Hepatología, Hospital Gustavo Fricke, Viña del Mar, Chile.,Departamento de Infectología, Hospital Gustavo Fricke, Viña del Mar, Chile
| | - Felipe Peirano
- Escuela de Medicina, Universidad de Valparaíso, Valparaíso, Chile
| | - Pedro Acuña
- Escuela de Medicina, Universidad Andrés Bello, Viña del Mar, Chile
| | - Felipe Fuster
- Escuela de Medicina, Universidad Del Desarrollo, Santiago, Chile
| | | | - Rodrigo Ahumada
- Departamento de Infectología, Hospital Gustavo Fricke, Viña del Mar, Chile
| | - Marco Huilcaman
- Departamento de Infectología, Hospital Gustavo Fricke, Viña del Mar, Chile
| | - Mario Bruna
- Departamento de Infectología, Hospital Gustavo Fricke, Viña del Mar, Chile
| | - Werner Jensen
- Escuela de Medicina, Universidad de Valparaíso, Valparaíso, Chile.,Departamento de Infectología, Hospital Gustavo Fricke, Viña del Mar, Chile
| | - Francisco Fuster
- Unidad de Hepatología, Hospital Gustavo Fricke, Viña del Mar, Chile
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12
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Hepatitis B reverse seroconversion in a patient with well controlled HIV infection: a case report and a review of the literature. AIDS 2015; 29:246-8. [PMID: 25532610 DOI: 10.1097/qad.0000000000000532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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13
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Pallawela SNS, Sonnex C, Mabayoje D, Bloch E, Chaytor S, Johnson MA, Carne C, Webster DP. Positive hepatitis B virus core antibody in HIV infection--false positive or evidence of previous infection? J Med Virol 2014; 87:208-12. [PMID: 25174739 DOI: 10.1002/jmv.24048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2014] [Indexed: 02/06/2023]
Abstract
Isolated HBV core antibody (anti-HBc) is defined as the presence of anti-HBc with a negative HBV surface antigen (HBsAg) and HBV surface antibody (anti-HBs <10 IU/l). In patients infected with HIV with isolated anti-HBc, the aim was to determine: The prevalence of isolated positive anti-HBc; The most effective method of identifying which patients have had previous Hepatitis B Virus (HBV) infection; The prevalence of false positive anti-HBc. HBV serology results were identified from 539 patients infected with HIV sampled between January 2010 and December 2012. In those with an isolated anti-HBc and negative anti-HBe, a second anti-HBc test was carried out using a different assay. Samples were also screened for HBV DNA. The anti-retroviral regimens at time of screening were documented. 101/539 had an isolated anti-HBc. Of these, 32 (32%) had a positive anti-HBe (including 1 equivocal) and 69(68%) were anti-HBe negative. Of those negative for anti-HBe, 32 were tested for both DNA and a second anti-HBc. Of these 26 (81%) were on cART at time of HBV testing, with 25 (78%) on ART with anti-HBV activity. The prevalence of isolated anti-HBc was 19%. Only 32% were also anti-HBe positive, whereas 97% of those anti-HBe negative were positive on a second anti-HBc assay suggesting lack of utility of anti-HBe in resolving serological quandaries. One subject (3%) had a false positive anti-HBc. There was no evidence of chronic HBV but 78% patients were on HBV-suppressive combination anti-retroviral therapy.
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Affiliation(s)
- S N S Pallawela
- Department of HIV Medicine, Royal Free London NHS Foundation Trust, London, United Kingdom; Department of GU Medicine, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom
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14
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Karaosmanoglu HK, Aydin OA, Nazlican O. Isolated anti-HBc among HIV-infected patients in Istanbul, Turkey. HIV CLINICAL TRIALS 2014; 14:17-20. [PMID: 23372111 DOI: 10.1310/hct1401-17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Isolated antibody to hepatitis B core antigen (anti-HBc) is frequent in HIV-infected patients, and it may be a marker of occult hepatitis B. We aimed to determine the prevalence and associated risk factors of isolated anti-HBc among HIV-infected patients in Turkey, which is classified as an intermediate HBV, low HIV endemic region. METHOD HIV/AIDS patients followed by the Infectious Diseases and Clinical Microbiology Outpatient Clinic of Haseki Training and Research Hospital between January 2006 and March 2011 were included in this study. Medical records were reviewed to determine the prevalence of isolated anti-HBc and to identify the risk factors associated with isolated anti-HBc. The frequency of isolated anti-HBc in 209 HIV-infected patients was compared with 83 volunteer blood donors. RESULTS Of 209 HIV-infected patients, 40 subjects (19.1%) had isolated anti-HBc compared with control group, which consisted of 83 volunteer blood donors who had similar age (P = .13) and sex (P = .29). In the control group, only 2 (2.4%) had isolated anti-HBc. Isolated anti-HBc was significantly more frequent in HIV-infected patients (P < .001). The characteristics such as age, gender, injecting drug use, anti-HCV seropositivity, and CD4 cell counts were not significantly different between HIV-infected patients with or without isolated anti-HBc. Only 3 (7.5%) of HIV-infected patients had occult infection. CONCLUSION Prevalence of isolated anti-HBc in Turkish HIV-infected patients was 19.1%, which was significantly more frequent than in blood donors. Isolated anti-HBc could be associated with occult infection. Thus, all HIV-infected patients should be screened for anti-HBc before starting antiretroviral therapy.
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15
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Spontaneous reactivation of hepatitis B virus replication in an HIV coinfected patient with isolated anti-Hepatitis B core antibodies. Virol J 2014; 11:9. [PMID: 24444423 PMCID: PMC3902409 DOI: 10.1186/1743-422x-11-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 01/17/2014] [Indexed: 12/14/2022] Open
Abstract
Co-infections with HBV (hepatitis B virus) occur in HIV (human immunodeficiency virus) patients frequently. It has been reported that an effective treatment of HIV can also lead to a suppression of HBV and to anti-HBs seroconversion in HBV-infected patients. Here, we report a spontaneous reactivation of HBV replication in an HIV-infected patient with anti-HBc as the only marker of chronic HBV infection. The patient was known to be coinfected with HIV and HBV for years and the HBV DNA was measured repeatedly at low levels. A significant increase of HBV DNA up to 1.7x107 IU/ml was found accompanied with clinical symptoms of hepatitis. Multiple mutations occurred in the S gene during the flare-up of HBV as shown by sequencing, including I103T, K122R, M133I, F134V, D144E, V164E and L175S. Anti-HIV/HBV treatment led to a resolution of symptoms and to a decrease in the HIV RNA and HBV DNA viral load. It is possible that the accumulated mutations during HBV replication were selected and responsible for the reactivation.
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16
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Muro FJ, Fiorillo SP, Sakasaka P, Odhiambo C, Reddy EA, Cunningham CK, Buchanan AM. Seroprevalence of Hepatitis B and C Viruses Among Children in Kilimanjaro Region, Tanzania. J Pediatric Infect Dis Soc 2013; 2:320-6. [PMID: 24363930 PMCID: PMC3869471 DOI: 10.1093/jpids/pit018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 01/24/2013] [Indexed: 12/14/2022]
Abstract
BACKGROUND Data on human immunodeficiency virus (HIV) and hepatitis B virus (HBV) and hepatitis C virus (HCV) coinfection among children in Africa are limited. We evaluated the seroprevalence of both viruses among healthy, HIV-uninfected children and HIV-infected children in the Kilimanjaro region of northern Tanzania. METHODS HBV and HCV markers were assessed using serum and plasma samples from HIV-negative children ages 1 month to 18 years, recruited primarily from 2 hospital vaccination clinics; and HIV-infected children 1-16 years of age, enrolled in care and on highly active antiretroviral therapy (HAART). HBV markers included hepatitis B surface antigen (HBsAg), hepatitis B surface antibody, and hepatitis B core antibody (HBcAb). Evidence of any prior HBV infection was defined as a single positive HBsAg or HBcAb result; presumed chronic hepatitis B infection was defined as a single positive HBsAg result. HCV infection was assessed by anti-HCV enzyme-linked immunosorbent assay. RESULTS Samples from 547 children were tested. Of 157 children infected with HIV, 9.6% (95% CI: 4.9, 14.2) showed evidence of any HBV infection, compared to 2.1% (95% CI: .6, 3.5) of HIV-negative children. Children with HIV were much more likely to show evidence of HBV infection than children without HIV (odds ratio [OR] = 5.0, P < .0001). Prevalence of presumed chronic HBV infection was 2.9% (95% CI: 1.5, 4.3) overall. Again, prevalence was higher among HIV-infected children (7.0% [95% CI: 3.0, 11.0]) compared to HIV-negative children (1.3% [95% CI: .2, 2.4]; OR = 5.8 [P = .0003]). Of 546 samples tested for anti-HCV antibody, none were positive. CONCLUSION HBV seroprevalence is high among children in the Kilimanjaro Region, with a significantly higher prevalence among children who are infected with HIV. Routine screening for HBV is needed among HIV-infected children. Patients with coinfection require closer monitoring of liver transaminases due to potential for hepatic toxicities, and they may need HAART regimens that will target both viruses. Guidelines for the management of coinfected children are urgently needed.
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Affiliation(s)
| | - Suzanne P. Fiorillo
- Division of Infectious Diseases, University of Colorado, Denver School of Medicine, Aurora
| | | | | | - Elizabeth A. Reddy
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania,Divison of Infectious Diseases, Department of Medicine, Duke University Medical Center,Duke Global Health Institute, Duke University
| | - Coleen K. Cunningham
- Division of Infectious Diseases, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Ann M. Buchanan
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania,Duke Global Health Institute, Duke University,Division of Infectious Diseases, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina,Corresponding Author: Ann M. Buchanan, MD, MPH, DTM&H, KCMC-Duke Collaboration, Kilimanjaro Christian Medical Centre, Box 3010, Moshi, Tanzania. E-mail:
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17
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Prevalence of occult hepatitis B virus infection in a cohort of HIV-positive patients resident in Sicily, Italy. BIOMED RESEARCH INTERNATIONAL 2013; 2013:859583. [PMID: 24063015 PMCID: PMC3770005 DOI: 10.1155/2013/859583] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 07/12/2013] [Accepted: 07/25/2013] [Indexed: 12/18/2022]
Abstract
Occult hepatitis B virus (OBI) in HIV-infected groups is still debated, as well as the associated risk-factors and clinical significance.
In this paper, we examined a total of 405 HBsAg-negative/HIV-infected patients enrolled from January 2007 to December 2009. Overall, the prevalence of OBI was 5.9% (95% confidence interval (CI95%): 3.8–8.7%); it was more frequently associated with “anti-HBc alone” serological marker (11.3%; adjusted odds ratio = 3.7, CI95%: 1.4–9.8), although it was also detected in the absence of any HBV serological marker (4.9%; CI95%: 2.3–9.1%). A low prevalence of anti-HCV-positive patients with OBI was found (3.1%; CI95%: 0.6–8.7%). HIV RNA plasma levels or other immunological/clinical characteristics were not significantly associated with OBI. All but one occult HBV infections were sustained by genotype D viral strains. OBI is relatively frequent in HIV-infected patients, although it does not seem to exert a relevant clinical impact. Viral genotypes in occult HBV infections reflect those circulating in the Mediterranean area.
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Abstract
OBJECTIVE This study aimed to determine the prevalence of serological markers for hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), and occult HBV infection among injection drug users (IDUs) with isolated anti-hepatitis B core (anti-HBc). METHODS A total of 153 male IDUs were tested for anti-hepatitis B surface (anti-HBs), hepatitis B surface antigen (HBsAg), anti-HBc, anti-HCV, and anti-HIV. The presence of HBV-DNA was determined in plasma samples of individuals with isolated anti-HBc (HBsAg negative, anti-HBs negative, and anti-HBc positive) by polymerase chain reaction (PCR). RESULTS The prevalence of markers for viral hepatitis and HIV infections was 59.5% for anti-HCV, 44.4% for anti-HBs, 22.9% for anti-HBc, 7.2% for HBsAg, and 5.9% for anti-HIV. Several markers for coinfection, including HBV-HCV (5.9%), HCV-HIV (5.2%), HBV-HIV (2.0%), and HBV-HCV-HIV (1.3%), were present. Of the 7.2% of IDUs with isolated anti-HBc, all were anti-HCV positive and 18.2% were anti-HIV positive; however, no cases had detectable HBV-DNA as a marker of occult infection. CONCLUSIONS Markers for HCV, HBV, HIV, and combinations of these infections were common among IDUs in a city of central Iran. Isolated anti-HBc was associated with HCV but not with occult HBV infection in this sample. The 10-fold higher prevalence of HCV than HIV infection may be a harbinger of increasing HIV among IDUs in this area.
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19
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Chen X, He JM, Ding LS, Zhang GQ, Zou XB, Zheng J. Prevalence of hepatitis B virus and hepatitis C virus in patients with human immunodeficiency virus infection in Central China. Arch Virol 2013; 158:1889-94. [PMID: 23553454 DOI: 10.1007/s00705-013-1681-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2012] [Accepted: 02/19/2013] [Indexed: 12/18/2022]
Abstract
Co-infection of hepatitis B virus (HBV) and/or hepatitis C virus (HCV) with human immunodeficiency virus (HIV) has an adverse effect on liver disease progression. This study investigated the prevalence of HBV and/or HCV co-infection in HIV-infected patients in Central China. A total of 978 HIV-infected patients from Hunan Province were enrolled. HBV serum markers, anti-hepatitis-C-virus antibody (anti-HCV), HBV DNA, and HBV genotypes were analyzed. The prevalence of hepatitis B surface antigen (HBsAg) and anti-HCV in HIV-infected patients was 19.4 % and 62.4 %, respectively. The prevalence of anti-HCV in HIV-positive intravenous drug users was 93.6 %. Among HBsAg-positive patients, 88.1 % were found to have at least one HBV serum marker. The rates of HIV mono-infection, HBV/HIV dual infection, HCV/HIV dual infection, and HBV/HCV/HIV triple infection were 30.4 %, 7.2 %, 50.2 %, and 12.2 %, respectively. Antibody to HBsAg (Anti-HBs) was more common in anti-HCV-positive than anti-HCV-negative patients (53.3 % vs 40.2 %, P = 0.000), but isolated hepatitis B core antibody (anti-HBc) was more common in anti-HCV-negative than anti-HCV-positive patients (24.2 % vs 12.3 %, P = 0.000). Hepatitis B e antigen (HBeAg) and sexual transmission were independent risk factors for active HBV replication. Intravenous drug use and male sex were independent risk factors, but old age and presence of HBeAg were independent protective factors for anti-HCV. Co-infection of HBV and/or HCV with HIV infection is common in central China. HCV status is associated with anti-HBs and isolated anti-HBc in co-infected patients.
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Affiliation(s)
- Xi Chen
- Hunan Provincial Center for Diseases Control and Prevention, 450 Furongzhong Rd. sec 1, Changsha 410005, China.
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20
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Khamduang W, Ngo-Giang-Huong N, Gaudy-Graffin C, Jourdain G, Suwankornsakul W, Jarupanich T, Chalermpolprapa V, Nanta S, Puarattana-Aroonkorn N, Tonmat S, Lallemant M, Goudeau A, Sirirungsi W. Prevalence, risk factors, and impact of isolated antibody to hepatitis B core antigen and occult hepatitis B virus infection in HIV-1-infected pregnant women. Clin Infect Dis 2013; 56:1704-12. [PMID: 23487379 DOI: 10.1093/cid/cit166] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Prevalence and risk factors for isolated antibody to hepatitis B core antigen (anti-HBc) and occult hepatitis B virus (HBV) infection are not well known in human immunodeficiency virus type 1 (HIV-1)-infected pregnant women. It is unclear if women with occult infections are at risk of transmitting HBV to their infants. METHODS HIV-1-infected and HBV surface antigen (HBsAg)-negative pregnant women were tested for antibody to HBsAg (anti-HBs) and anti-HBc using enzyme immunoassay. Women with isolated anti-HBc were assessed for occult HBV infection, defined as HBV DNA levels >15 IU/mL, using the Abbott RealTime HBV DNA assay. Infants born to women with isolated anti-HBc and detectable HBV DNA were tested at 4 months of age for HBV DNA. Logistic regression analysis was used to identify factors associated with isolated anti-HBc and occult HBV infection. RESULTS Among 1812 HIV-infected pregnant women, 1682 were HBsAg negative. Fourteen percent (95% confidence interval [CI], 12%-15%) of HBsAg-negative women had an isolated anti-HBc that was independently associated with low CD4 count, age >35 years, birth in northern Thailand, and positive anti-hepatitis C virus serology. Occult HBV infection was identified in 24% (95% CI, 18%-30%) of women with isolated anti-HBc, representing 2.6% (95% CI, 1.9%-3.5%) of HIV-1-infected pregnant women, and was inversely associated with HIV RNA levels. None of the women with isolated anti-HBc and occult HBV infection transmitted HBV to their infants. CONCLUSIONS HIV-1-infected pregnant women with isolated anti-HBc and occult HBV infection have very low HBV DNA levels and are thus at very low risk to transmit HBV to their infants.
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Affiliation(s)
- Woottichai Khamduang
- Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai. Thailand
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Gatanaga H, Hayashida T, Tanuma J, Oka S. Prophylactic effect of antiretroviral therapy on hepatitis B virus infection. Clin Infect Dis 2013; 56:1812-9. [PMID: 23487374 DOI: 10.1093/cid/cit145] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Hepatitis B virus (HBV) infection is common in individuals infected with human immunodeficiency virus, especially in men who have sex with men (MSM). Almost all currently used regimens of antiretroviral therapy (ART) contain lamivudine (LAM) or tenofovir disoproxil fumarate (TDF), both of which have significant anti-HBV activity. However, the prophylactic effect of ART on HBV infection has not been assessed previously. METHODS Non-HBV-vaccinated HIV-infected MSM were serologically evaluated for HBV infection using stocked serum samples. Cases negative for HBV surface antigen (HBsAg), antibody to HBsAg (anti-HBs), and antibody to HBV core antigen (anti-HBc) in first serum samples were serologically followed until last available stocked samples. HBV genotype and LAM-resistant mutation (rtM204V/I) were analyzed in cases that became HBsAg-positive. RESULTS The first stocked samples were negative for all analyzed HBV serological markers in 354 of 1434 evaluated patients. The analysis of their last samples indicated HBV incident infection in 43 of them during the follow-up period. The rate of incident infections was lower during LAM- or TDF-containing ART (0.669 incident infections in 100 person-years) than during no ART period (6.726 incident infections in 100 person-years) and other ART (5.263 incident infections in 100 person-years) (P < .001). Genotype A was most prevalent (76.5%), and LAM-resistant HBV was more frequent in incident infections during LAM-containing ART (50.0%) than in those during no ART and other ART (7.1%) (P = .029). CONCLUSIONS LAM- and TDF-containing ART regimens seem to provide prophylaxis against HBV infection, although drug-resistant strains seem to evade these effects.
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Affiliation(s)
- Hiroyuki Gatanaga
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan.
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22
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López-Serrano P, Pérez-Calle JL, Sánchez-Tembleque MD. Hepatitis B and inflammatory bowel disease: Role of antiviral prophylaxis. World J Gastroenterol 2013; 19:1342-8. [PMID: 23538480 PMCID: PMC3602492 DOI: 10.3748/wjg.v19.i9.1342] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Revised: 08/22/2012] [Accepted: 08/25/2012] [Indexed: 02/06/2023] Open
Abstract
Hepatitis B virus (HBV) is a very common infection worldwide. Its reactivation in patients receiving immunosuppression has been widely described as being associated with significant morbidity and mortality unless anti-viral prophylaxis is administered. Treatment in inflammatory bowel disease (IBD) patients has changed in recent years and immunosuppression and biological therapies are now used more frequently than before. Although current studies have reported an incidence of hepatitis B in inflammatory bowel disease patients similar to that in the general population, associated liver damage remains an important concern in this setting. Liver dysfunction may manifest in several ways, from a subtle change in serum aminotransferase levels to fulminant liver failure and death. Patients undergoing double immunosuppression are at a higher risk, and reactivation usually occurs after more than one year of treatment. As preventive measures, all IBD patients should be screened for HBV markers at diagnosis and those who are positive for the hepatitis B surface antigen should receive antiviral prophylaxis before undergoing immunosuppression in order to avoid HBV reactivation. Tenofovir/entecavir are preferred to lamivudine as nucleos(t)ide analogues due to their better resistance profile. In patients with occult or resolved HBV, viral reactivation does not appear to be a relevant issue and regular DNA determination is recommended during immunosuppression therapy. Consensus guidelines on this topic have been published in recent years. The prevention and management of HBV infection in IBD patients is addressed in this review in order to address practical recommendations
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Witt MD, Lewis RJ, Rieg G, Seaberg EC, Rinaldo CR, Thio CL. Predictors of the isolated hepatitis B core antibody pattern in HIV-infected and -uninfected men in the multicenter AIDS cohort study. Clin Infect Dis 2012; 56:606-12. [PMID: 23090927 DOI: 10.1093/cid/cis908] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The significance of hepatitis B core antibody (anti-HBc) without hepatitis B surface antigen (HBsAg) or hepatitis B surface antibody (anti-HBs) is unclear. METHODS This cohort study included men enrolled in the Multicenter AIDS Cohort to determine clinical and laboratory predictors of isolated anti-HBc. RESULTS A total of 2286 subjects (51% human immunodeficiency virus [HIV]-infected) were followed over 3.9 years. Overall, 16.9% (387) had at least 1 visit with isolated anti-HBc. The isolated anti-HBc pattern was stable 84% of the time, and transitioned to or from a pattern of past infection (anti-HBc and anti-HBs). Isolated anti-HBc was associated with HIV infection (odds ratio [OR], 2.19; 95% confidence interval [CI], 1.73-2.79) and hepatitis C virus (HCV; OR, 4.21; 95% CI; 2.99-5.91). The HCV association was stronger for chronic HCV infection (OR, 6.76; 95% CI, 5.08-8.99) than for cleared HCV (OR, 3.03; 95% CI, 1.83-5.03). HIV infection, chronic HCV, and cleared HCV infection all remained associated with isolated anti-HBc in multivariable models (OR, 1.74; 95% CI, 1.33-2.29; OR, 6.24; 95% CI, 4.62-8.42; and OR, 2.77; 95% CI, 1.65-4.66, respectively). Among HIV-infected subjects, highly active antiretroviral therapy was negatively associated (OR, 0.79; 95% CI, .66-.95) with isolated anti-HBc. CONCLUSIONS Isolated anti-HBc is associated with HIV and HCV coinfection, especially active HCV replication, and most commonly occurs as a transition to or from the pattern of natural immunity (anti-HBc and anti-HBs). The isolated anti-HBc pattern likely represents resolved HBV infection with low or undetected anti-HBs.
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Affiliation(s)
- Mallory D Witt
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, orrance, CA 90509, USA.
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Aurpibul L, Lumbiganon P, Kolasaraksa P, Hansudewechakul R, Sa-nguanmoo P, Taeprasert P, Bunupuradah T, Pooworawan Y, Sirisanthana V, Puthanakit T. HIV and Hepatitis B coinfection among perinatally HIV-infected Thai adolescents. Pediatr Infect Dis J 2012; 31:943-7. [PMID: 22592516 PMCID: PMC3511890 DOI: 10.1097/inf.0b013e31825eb0ad] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVES This study aimed to determine the prevalence of hepatitis B virus (HBV) coinfection and HBV seropositivity in perinatally HIV-infected adolescents. A secondary objective was to describe the clinical characteristics of adolescents with chronic HBV/HIV coinfection. MATERIALS AND METHODS Multicenter cross-sectional study of perinatally HIV-infected adolescents aged 12-25 years. HBV surface antigen, surface antibody (anti-HBs) and core antibody (anti-HBc) were measured. Coinfection was defined as having persistently positive HBV surface antigen. Seroprotective antibody from immunization was defined as having anti-HBs ≥10 mIU/mL with negative anti-HBc. HBV DNA quantitation and rtM204V/I mutation analysis (lamivudine resistance-associated mutation) were performed in adolescents with chronic HBV infection. RESULTS From November 2010 to March 2011, 521 patients were enrolled. Mean (SD) of CD4 lymphocyte count was 685 (324) cells/μL. The prevalence of HBV/HIV coinfection was 3.3% (95% confidence interval: 1.9-5.2%). Protective antibody against HBV was found in 18% of population, and this was significantly higher among adolescents who received than those who did not receive HBV revaccination after receiving antiretroviral therapy (93% versus 6%, P < 0.01). Among adolescents with chronic HBV infection, 88% have received lamivudine; however, 69% have HBV DNA >10 copies/mL and 75% had the rtM204V/I mutation. CONCLUSIONS The prevalence of HBV coinfection in HIV-infected Thai adolescents was 3.3%. Most HIV-infected adolescents had no HBV protective antibody; therefore, revaccination with HBV vaccine is encouraged. The high prevalence of HBV-lamivudine resistance underscores the importance of HBV screening prior to antiretroviral therapy initiation to guide the selection of optimal regimen for coinfected children.
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Affiliation(s)
- Linda Aurpibul
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai
| | | | | | | | - Pattaratida Sa-nguanmoo
- The Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University
| | | | - Torsak Bunupuradah
- The Netherlands, Australia, Thailand Research Collaboration (HIVNAT), Bangkok
| | - Yong Pooworawan
- The Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University
| | - Virat Sirisanthana
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai
| | - Thanyawee Puthanakit
- The Netherlands, Australia, Thailand Research Collaboration (HIVNAT), Bangkok
- Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Aghakhani A, Banifazl M, Velayati AA, Eslamifar A, Ramezani A. Occult hepatitis B virus infection in hemodialysis patients: a concept for consideration. Ther Apher Dial 2012; 16:328-33. [PMID: 22817120 DOI: 10.1111/j.1744-9987.2012.01072.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Hemodialysis patients potentially have an increased risk of infection with parenterally transmitted viral agents due to an impaired host immune response and multiple transfusion requirements. Viral hepatitis is considered as a problem for hemodialysis patients because 1.9% of all deaths among this population are related to the consequence of viral hepatitis. Hepatitis B virus (HBV) is one of the most important causes of transmitted infections by the parenteral route in hemodialysis patients. Occult HBV infection is characterized by presence of HBV infection without detectable hepatitis B surface antigen (HBsAg), which harbors potential risk of HBV transmission through hemodialysis. There are conflicting reports on the prevalence of occult HBV infection (OBI) in hemodialysis patients. Considering the importance of occult HBV infection in hemodialysis patients and the growing evidence on this subject, the purpose of this review is to provide comprehensive information on OBI prevalence in hemodialysis patients and highlight the most important points in this issue.
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Affiliation(s)
- Arezoo Aghakhani
- Clinical Research Department, Pasteur Institute of Iran, Tehran, Iran
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Su FH, Bai CH, Chu FY, Lin YS, Su CT, Yeh CC. Significance and anamnestic response in isolated hepatitis B core antibody-positive individuals 18 years after neonatal hepatitis B virus vaccination in Taiwan. Vaccine 2012; 30:4034-9. [PMID: 22531558 DOI: 10.1016/j.vaccine.2012.04.031] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Revised: 04/05/2012] [Accepted: 04/09/2012] [Indexed: 01/01/2023]
Abstract
AIM To investigate the significance of isolated hepatitis B core antibody (anti-HBc) and to analyze the response to hepatitis B virus (HBV) booster vaccination in young adults with isolated anti-HBc who had been fully vaccinated with HBV vaccine as infants. MATERIALS AND METHODS We screened 1734 new university entrants who had been fully vaccinated against HBV in infancy for the presence of hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (anti-HBs), and anti-HBc upon university entry. Results positive for isolated anti-HBc were reconfirmed by testing for the presence of HBsAg and anti-HBc once more, and further evaluated for anti-HCV, anti-HIV, and HBV DNA status 6 months later. Students were also offered HBV booster vaccinations at that time. Geometric mean titers (GMT) of anti-HBs after one booster dose of HBV were compared between students with isolated anti-HBc and students with HBV naïve status. RESULTS The overall prevalence of isolated anti-HBc in our student cohort was 1.2% (21 of 1734). No evidence of occult HBV infection was observed. A "booster" anamnestic response (anti-HBs titer ≥ 10 mIU/mL) was noted in 95% (20 of 21) of subjects with isolated anti-HBc. After re-measurement of anti-HBc, 13 (62%) of the 21 subjects with isolated anti-HBc were reclassified as having resolved HBV infection with a loss of anti-HBs. In the remaining 8 subjects (38%), isolated anti-HBc was determined to be false positive. The HBV status of these 8 subjects was HBV naïve due to the waning-off effect of anti-HBs of the neonatal HBV vaccination. There was no significant difference in anamnestic response to a single HBV booster dose of vaccine between students with isolated anti-HBc (n=13) and those with HBV naïve (n=323) status (GMT 50.6 vs 47.7 mIU/mL, P=0.90). CONCLUSION The presence of isolated anti-HBc 18 years after HBV vaccination can be attributed to post-HBV infection with a loss of anti-HBs and to a decline in anti-HBs elicited by vaccine. A single HBV booster dose of vaccine is recommended for subjects with isolated anti-HBc who were fully vaccinated with HBV vaccine as infants. This finding needs to be replicated in further studies with larger cohorts.
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Affiliation(s)
- Fu-Hsiung Su
- School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan
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Challenges in Providing Treatment and Care for Viral Hepatitis among Individuals Co-Infected with HIV in Resource-Limited Settings. AIDS Res Treat 2012; 2012:948059. [PMID: 22536498 PMCID: PMC3318196 DOI: 10.1155/2012/948059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Accepted: 12/06/2011] [Indexed: 12/14/2022] Open
Abstract
Hepatitis B and C infections are prevalent among HIV-infected individuals with different epidemiologic profiles, modes of transmission, natural histories, and treatments. Southeast Asian countries are classified as "highly prevalent zones," with a rate of hepatitis B and C coinfection in people living with HIV/AIDS of approximately 3.2-11%. Majority of hepatitis B coinfection is of genotype C. Most of the patients infected with hepatitis C in Thailand have genotype 3 which is significantly related to intravenous drug use whereas, in Vietnam, it is genotype 6. The options for antiretroviral drugs are limited and rely on global funds and research facilities. Only HBV treatment is available for free through the national health scheme. Screening tests for HBV and HCV prior to commencing antiretroviral treatment are low. Insufficient concern on hepatitis-virus-related liver malignancy and long-term hepatic morbidities is noted. Cost-effective HCV treatment can be incorporated into the national health program for those who need it by utilizing data obtained from clinical research studies. For example, patients infected with HCV genotype 2/3 with a certain IL-28B polymorphism can be treated with a shorter course of interferon and ribavirin which can also help reduce costs.
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Launay O, Masurel J, Servant-Delmas A, Basse-Guérineau AL, Méritet JF, Laperche S, Sogni P, Rosenberg AR. High levels of serum hepatitis B virus DNA in patients with 'anti-HBc alone': role of HBsAg mutants. J Viral Hepat 2011; 18:721-9. [PMID: 21914087 DOI: 10.1111/j.1365-2893.2011.01482.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
It remains unclear how the detection of hepatitis B core antibody (anti-HBc) in the absence of hepatitis B surface antigen (HBsAg) and antibody (anti-HBs) should be interpreted and whether all patients with this pattern need to be tested for hepatitis B virus (HBV)-DNA. This study aimed at reassessing the significance of 'anti-HBc alone' in unselected sera referred to the clinical laboratory and determining whether significant HBV viraemia can be found in this setting. Of the 6431 patients tested for HBsAg, total anti-HBc and anti-HBs in a Paris hospital over a 1-year period, 362 (5.6%) had 'anti-HBc alone' (24.8% of anti-HBc-positive patients). Only 11 of the 362 sera (3.0%) were found to be false positive. One patient was in the resolving phase of acute hepatitis B. HBV-DNA was detected in 10 of 362 (2.8%) patients, using a commercial standardized assay (threshold: 350 IU/mL). Viral loads exceeded 10(4) copies/mL in 6 of 10 patients. Mutations in the HBsAg immunodominant region were identified in seven of the viraemic patients. HBsAg was detected in only two cases when retested by one of the latest, multivalent assays. Neither human immunodeficiency virus nor hepatitis C virus serostatus distinguished between patients with and without HBV-DNA. In conclusion, 'anti-HBc alone' should be considered a risk marker for a so-called 'false occult' HBV infection with significant viraemia. Indeed, results in this hospital population indicate that a small proportion of patients with 'anti-HBc alone' have high viral loads, revealing the occurrence of infection with HBV mutants that escape detection even by multivalent HBsAg assays.
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Affiliation(s)
- O Launay
- Université Paris Descartes, Faculté de Médecine, Paris, France
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Price JC, Thio CL. Liver disease in the HIV-infected individual. Clin Gastroenterol Hepatol 2010; 8:1002-12. [PMID: 20851211 PMCID: PMC2997131 DOI: 10.1016/j.cgh.2010.08.024] [Citation(s) in RCA: 144] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2010] [Revised: 08/25/2010] [Accepted: 08/28/2010] [Indexed: 02/07/2023]
Abstract
Since the advent of effective antiretroviral therapy (ART) for human immunodeficiency virus-1 (HIV), there has been a substantial decrease in deaths related to acquired immunodeficiency syndrome (AIDS). However, in the ART era, liver disease is now the most common non-AIDS-related cause of death among HIV-infected patients, accounting for 14%-18% of all deaths in this population and almost half of deaths among hospitalized HIV-infected patients. Just as the burden of non-AIDS morbidity and mortality has changed in the ART era, the types of liver disease the clinician is likely to encounter among these patients have changed as well. This review will discuss the causes of liver disease in the HIV-infected population in the ART era, including chronic hepatitis C virus, chronic hepatitis B virus, medication-related hepatotoxicity, alcohol abuse, nonalcoholic fatty liver disease, and AIDS-related liver diseases.
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Affiliation(s)
- Jennifer C Price
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland 21287, USA.
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30
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Kang SY, Kim MH, Lee WI. The prevalence of "anti-HBc alone" and HBV DNA detection among anti-HBc alone in Korea. J Med Virol 2010; 82:1508-14. [PMID: 20648604 DOI: 10.1002/jmv.21862] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The "anti-HBc alone" is a frequent serological finding in clinical laboratories, making it difficult to determine whether the HBV infection has resolved. The objectives of this study were to investigate the prevalence of anti-HBc alone and HBV DNA detection (occult HBV infection) among anti-HBc alone, and to describe the demographic and clinical characteristics of anti-HBc alone. A total of 17,677 sera referred from the Health Promotion Center (HPC group, 4,014 sera) as well as all the hospital clinical departments (Patient group, 13,663 sera) were tested for HBs Ag, anti-HBc, and anti-HBs. HBV DNA test using real-time PCR was performed on 230 anti-HBc alone. The prevalence of anti-HBc alone was 8.9%, significantly higher in the Patient group than in the HPC group. The prevalence of anti-HBc was higher in men than women and was increased with age. Very low levels of HBV DNA were found in only 4 (1.7%) out of 230 subjects with anti-HBc alone. They were patients with conditions unrelated to chronic liver disease. Considering the high prevalence of anti-HBc alone, the frequency of occult HBV infection among anti-HBc alone was unexpectedly low. In addition, HBV viral load was low in these patients. Further studies are required to determine the clinical significance and infectivity of anti-HBc alone, in conjunction with very low levels of HBV DNA and to standardize the detection methodology for both anti-HBc alone and HBV DNA.
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Affiliation(s)
- So-Young Kang
- Department of Laboratory Medicine, The East-West Neo Medical Center, School of Medicine, KyungHee University, Seoul, Korea
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31
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Sun HY, Lee HC, Liu CE, Yang CL, Su SC, Ko WC, Lin CY, Tsai JJ, Wong WW, Ho MW, Cheng SH, Lin YH, Miao WJ, Hung CC. Factors associated with isolated anti-hepatitis B core antibody in HIV-positive patients: impact of compromised immunity. J Viral Hepat 2010; 17:578-87. [PMID: 19818002 DOI: 10.1111/j.1365-2893.2009.01212.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
In regions that are hyperendemic for chronic hepatitis B virus (HBV) infection, prevalence of and risk factors associated with isolated anti-hepatitis B core antibody (anti-HBc) in HIV-positive patients are less well described. HIV-positive patients who were tested for hepatitis B surface antigen (HBsAg), anti-hepatitis B surface antibody (anti-HBs) and anti-HBc at designated hospitals for HIV care in Taiwan were included for analysis. HBV DNA was detected by real-time polymerase chain reaction in patients with and without isolated anti-HBc. Of 2351 HIV-positive patients, 450 (19.1%) were HBsAg positive, 411 (17.5%) were anti-HBc positive alone and 963 (41.0%) for both anti-HBs and anti-HBc. Compared with patients who were positive for both anti-HBs and anti-HBc, patients with isolated anti-HBc were older, less likely to have anti-hepatitis C virus antibody (anti-HCV), had lower CD4 lymphocyte counts and higher plasma HIV RNA loads. Older age (adjusted odds ratio, 1.029; 95% confidence interval, 1.015-1.043) and CD4 <100 cells/microL (adjusted odds ratio, 1.524; 95% confidence interval, 1.025-2.265) were independently associated with isolated anti-HBc by logistic regression, while presence of anti-HCV and injecting drug use were not. HBV DNA was detectable in 8.3% of 277 patients with isolated anti-HBc and 14.3% of 56 patients with both anti-HBs and anti-HBc (P = 0.160). In a country hyperendemic for HBV infection, HIV-positive patients at older age and with CD4 <100 cells/microL were more likely to have isolated anti-HBc, suggesting that compromised immunity plays a role in the presence of this marker.
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Affiliation(s)
- H-Y Sun
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Risk factors of isolated antibody against core antigen of hepatitis B virus: association with HIV infection and age but not hepatitis C virus infection. J Acquir Immune Defic Syndr 2010; 54:122-8. [PMID: 20386111 DOI: 10.1097/qai.0b013e3181daafd5] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Isolated antibody to hepatitis B core antigen (anti-HBc) is defined as seropositivity for anti-HBc in the absence of hepatitis B surface antigen (HBsAg) and antibody to HBsAg (anti-HBs). It is commonly found in HIV-infected persons or hepatitis C virus (HCV)-infected persons, but the risk factors for isolated anti-HBc remain uncertain, especially in regions that are hyperendemic for hepatitis B virus (HBV) infection. METHODS This cross-sectional study included a cohort of 955 nonhemophiliac, HIV-infected patients, diagnosed between 1988 and 2009, and 643 HIV-uninfected injection drug users (IDUs) attending the methadone clinic between August 2007 and May 2009, with available HBV serological data. The medical records were reviewed to identify the risk factors associated with seropositivity of isolated anti-HBc. RESULTS The overall seroprevalence of isolated anti-HBc was 12.1% (193 of 1598), in which occult HBV infection accounted for 1.6% (3 of 185) and the majority (91.2 %, 176 of 193) had low titers of anti-HBs (3.6 +/- 2.9 IU/L). Subjects with isolated anti-HBc were significantly older (40.7 +/- 9.3 versus 36.9 +/- 8.0, respectively, P < 0.0001). There was a significantly increasing trend in the prevalence of isolated anti-HBc with age, from 4.0% in those younger than 30 years to 22.5% after 50 years of age (test for trend, P < 0.0001). A significantly higher prevalence of isolated anti-HBc was observed in HIV-infected subjects [14.0% (134 of 955) versus 9.2% (59 of 643), adjusted odds ratio, 1.64; P < 0.01], but not in those with HCV infection (P = 0.18). CONCLUSIONS Isolated anti-HBc seropositivity was significantly associated with HIV infection, and older age. HCV infection was not associated with isolated anti-HBc in a country hyperendemic with HBV infection, even in populations with a high prevalence of HCV infection. The majority was not attributable to occult HBV infection, but rather, low level of anti-HBs, suggesting that HBV vaccination may not be required.
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Hakeem L, Thomson G, McCleary E, Bhattacharyya D, Banerjee I. Prevalence and Immunization Status of Hepatitis B Virus in the HIV Cohort in Fife, Scotland. J Clin Med Res 2010; 2:34-8. [PMID: 22457699 PMCID: PMC3299173 DOI: 10.4021/jocmr2009.12.1282] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2009] [Indexed: 12/20/2022] Open
Abstract
Background Routes of transmission of hepatitis B virus (HBV)/HIV infections are similar and there is a significant rate of co-infection in patients. A study was recently carried out in NHS Fife, Scotland from February 2007 - February 2008 to estimate the prevalence of HBV/HIV co-infection, occult HBV infection and immunisation status against HBV in a cohort of patients with HIV attending the departments of infectious diseases and genitourinary medicine. Methods Case notes were reviewed retrospectively (n = 70). Details on patient demographics, risk category, nadir/current CD4 count, HIV viral load and vaccination history were analysed. HBV markers (HBsAg/anti-HBs/anti-HBc/HBV DNA) and alanine transaminase (ALT) levels were tested prospectively if these tests had not been carried out in the previous 12 months. Results and Conclusion Prevalence of HBV/HIV co-infection was 5.6% of which 2.8% of patients had occult infection and 22.9% had evidence of previous exposure. Although HBV is preventable by vaccination, only 24.2% of patients had been vaccinated against it. Improvements could therefore be made in the field of prevention with vaccination and monitoring the immune response in this cohort. Keywords Prevalence; Immunization status; Hepatitis B Virus; HIV
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Affiliation(s)
- Lukman Hakeem
- Infectious Diseases Unit, Victoria Hospital (NHS Fife), Kirkcaldy, Fife, Scotland, UK
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34
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Kozłowska J, Mikuła T, Staćczak W, Wiercićska-Drapało A. Hepatitis B prophylaxis in HIV-infected patients. HIV & AIDS REVIEW 2010. [DOI: 10.1016/s1730-1270(11)60002-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Sofian M, Aghakhani A, Izadi N, Banifazl M, Kalantar E, Eslamifar A, Ramezani A. Lack of occult hepatitis B virus infection among blood donors with isolated hepatitis B core antibody living in an HBV low prevalence region of Iran. Int J Infect Dis 2009; 14:e308-10. [PMID: 19656713 DOI: 10.1016/j.ijid.2009.05.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2009] [Revised: 05/10/2009] [Accepted: 05/18/2009] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Occult hepatitis B virus (HBV) infection in blood donors is considered a potential threat for the safety of the blood supply, however conclusive studies on this issue are lacking. The aim of this study was to assess the occult HBV infection in blood donors with isolated hepatitis B core antibody (anti-HBc) living in the city of Arak, in the Central Province of Iran, as a low prevalence region for HBV. METHODS A total of 531 voluntary blood donors in Arak, Iran were included in this study. Hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (anti-HBs), anti-HBc, and hepatitis C antibody (anti-HCV) were tested in all subjects. The presence of HBV-DNA was determined quantitatively in plasma samples of cases with isolated anti-HBc (HBsAg-negative, anti-HBs-negative, and anti-HBc-positive) by real-time PCR using the artus HBV RG PCR kit on the Rotor-Gene 3000 real-time thermal cycler. RESULTS Of 531 subjects enrolled in this study, 11 (2.1%, 95% confidence interval 0.8-3.2%) had isolated anti-HBc. HBV-DNA was not detected in any of the cases with isolated anti-HBc. CONCLUSIONS Our study showed that all the blood donors with isolated anti-HBc were negative for HBV-DNA, and occult HBV infection did not occur in the blood donors of this low prevalence region for HBV infection.
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Ramezani A, Mohraz M, Aghakhani A, Banifazl M, Eslamifar A, Khadem-Sadegh A, Velayati AA. Frequency of isolated hepatitis B core antibody in HIV-hepatitis C virus co-infected individuals. Int J STD AIDS 2009; 20:336-8. [PMID: 19386971 DOI: 10.1258/ijsa.2008.008377] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Association between isolated hepatitis B core antibody (anti-HBc) and hepatitis C virus (HCV) infection has been noted in HIV-infected individuals. This study describes the frequency of isolated anti-HBc and its possible value for the detection of HBV-DNA in HIV-infected patients with or without HCV co-infection. Ninety-two HIV-infected patients were enrolled in the study. Hepatitis B surface antigen (HBs Ag), anti-HBs, anti-HBc, anti-HCV, HIV viral load and CD4 count were tested in all subjects. Then we compared 63 subjects with HIV-HCV co-infection with 29 subjects with HIV infection alone regarding isolated anti-HBc (HBs Ag negative, anti-HBs negative and anti-HBc positive). The presence of HBV-DNA was determined by real-time polymerase chain reaction in serum samples of patients with isolated anti-HBc. Of 63 anti-HCV-positive patients, 18 subjects (28.6%, 95% [confidence interval] CI: 22.6-34.6%), and of 29 anti-HCV-negative patients, five subjects (17.2%, 95% CI: 11.5-22.9%) had isolated anti-HBc. HBV-DNA was detectable in three of 18 anti-HCV-positive patients (16.7%, 95% CI: 9.7-23.7%) and none of the anti-HCV-negative patients with isolated anti-HBc. Our study showed that individuals co-infected with HIV and HCV were more likely to have isolated anti-HBc than subjects with HIV alone. This investigation also demonstrates that the presence of isolated anti-HBc in HIV-HCV-infected individuals may reflect occult HBV infection in these patients.
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Affiliation(s)
- A Ramezani
- Clinical Research Department, Pasteur Institute of Iran, Tehran, Iran.
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Pérez-Rodríguez MT, Sopeña B, Crespo M, Rivera A, Blanco TGD, Ocampo A, Martínez-Vázquez C. Clinical significance of “anti-HBc alone” in human immunodeficiency virus-positive patients. World J Gastroenterol 2009; 15:1237-41. [PMID: 19291824 PMCID: PMC2658847 DOI: 10.3748/wjg.15.1237] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine the prevalence and clinical relevance of isolated antibodies to hepatitis B core antigen as the only marker of infection (“anti-HBc alone”) among human immunodeficiency virus (HIV) type-1 infected patients. Occult hepatitis B infection frequency was also evaluated.
METHODS: Three hundred and forty eight histories from 2388 HIV-positive patients were randomly reviewed. Patients with serological markers of hepatitis B virus (HBV) infection were classified into three groups: past hepatitis, “anti-HBc alone” and chronic hepatitis. Determination of DNA from HBV, and RNA and genotype from hepatitis C virus (HCV) were performed on “anti-HBc alone” patients.
RESULTS: One hundred and eighty seven (53.7%) HIV-positive patients had markers of HBV infection: 118 past infection (63.1%), 14 chronic hepatitis (7.5%) and 55 “anti-HBc alone” (29.4%). Younger age [2.3-fold higher per every 10 years younger; 95% confidence intervals (CI) 1.33-4.00] and antibodies to HCV infection [odds ratio (OR) 2.87; 95% CI 1.10-7.48] were factors independently associated with the “anti-HBc alone” pattern. No differences in liver disease frequency were detected between both groups. Serum levels of anti-HBs were not associated with HCV infection (nor viral replication or HCV genotype), or with HIV replication or CD4 level. No “anti-HBc alone” patient tested positive for HBV DNA.
CONCLUSION: “Anti-HBc alone” prevalence in HIV-positive patients was similar to previously reported data and was associated with a younger age and with antibodies to HCV infection. In clinical practice, HBV DNA determination should be performed only in those patients with clinical or analytical signs of liver injury.
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Lugoboni F, Quaglio G, Civitelli P, Mezzelani P. Bloodborne viral hepatitis infections among drug users: the role of vaccination. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2009; 6:400-13. [PMID: 19440291 PMCID: PMC2672321 DOI: 10.3390/ijerph6010400] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/26/2008] [Accepted: 01/20/2009] [Indexed: 12/16/2022]
Abstract
Drug use is a prevalent world-wide phenomenon and hepatitis virus infections are traditionally a major health problem among drug users (DUs). HBV and HCV, and to a lesser extent HAV, are easily transmitted through exposure to infected blood and body fluids. Viral hepatitis is not inevitable for DUs. Licensed vaccines are available for hepatitis A and hepatitis B. The purpose of this overview is to show some epidemiological data about HBV and the other blood-borne viral hepatitis among DUs and to summarize and discuss use of hepatitis vaccinations in this population. Successful vaccination campaigns among DUs are feasible and well described. We try to focus on the most significant results achieved in successful vaccination programs as reported in scientific literature. Vaccination campaigns among DUs represent a highly effective form of health education and they are cost-saving.
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Affiliation(s)
- Fabio Lugoboni
- Medical Unit for Addictive Disorders, Department of Internal Medicine, Policlinico GB Rossi, 37134 Verona, Italy; E-Mails:
;
- * Author to whom correspondence should be addressed; E-Mail:
; Tel +39-045-812-8292; Fax +39-045-812-8290
| | - Gianluca Quaglio
- Medical Unit for Addictive Disorders, Department of Internal Medicine, Policlinico GB Rossi, 37134 Verona, Italy; E-Mails:
;
| | - Paolo Civitelli
- Addiction Treatment Clinic (SerT-Asl 4), Thiene (Vicenza), Italy; E-Mail:
| | - Paolo Mezzelani
- Medical Unit for Addictive Disorders, Department of Internal Medicine, Policlinico GB Rossi, 37134 Verona, Italy; E-Mails:
;
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Kleinberg M. Viruses. MANAGING INFECTIONS IN PATIENTS WITH HEMATOLOGICAL MALIGNANCIES 2009. [PMCID: PMC7114983 DOI: 10.1007/978-1-59745-415-5_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Viral infections are an important and often unrecognized component of disease in immunocompromised patients. The diagnosis and management of viral infections have expanded largely because of new quantitative molecular diagnostic assays. Well-recognized pathogens such as herpes simplex virus (HSV), cytomegalovirus (CMV), and respiratory viruses have been joined by newly recognized pathogens such as BK virus, human herpesvirus-6 (HHV-6), and human metapneumovirus in this highly susceptible patient population. The role of Epstein-Barr virus (EBV) and Human herpesvirus-8 (HHV-8) in lymphoproliferative diseases also continue to be clarified. As a result, the management of viral infections in patients with hematologic malignancies continues to be a growing challenge for the clinician.
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Affiliation(s)
- Michael Kleinberg
- School of Medicine, University of Maryland, S. Greene St. 22, Baltimore, 21201 U.S.A
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Bailey CL, Smith V, Sands M. Hepatitis B vaccine: a seven-year study of adherence to the immunization guidelines and efficacy in HIV-1-positive adults. Int J Infect Dis 2008; 12:e77-83. [PMID: 18723381 DOI: 10.1016/j.ijid.2008.05.1226] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2008] [Revised: 05/06/2008] [Accepted: 05/19/2008] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Vaccination against hepatitis B virus (HBV) has been recommended for all high-risk adults since 1982. Since the advent of highly active antiretroviral therapy, few studies have examined adherence to the Infectious Diseases Society of America (IDSA) and Advisory Committee on Immunization Practices (ACIP) guidelines for hepatitis B vaccination in persons infected with HIV. METHODS This was a seven-year retrospective, cross-sectional analysis of HBV vaccination practices in HIV-1-positive adults treated in an urban ambulatory care center. Compliance with screening, hepatitis B vaccination recommendations, and response to vaccination were assessed. RESULTS Of the 1601 charts reviewed, 717 persons were eligible for vaccination against hepatitis B. Of these patients, 503 received at least one dose of vaccine, but only 356 patients completed the three-dose series. Vaccine response was associated with CD4 count (p=0.006) and viral load (p=0.001) at the time of the first dose. However, development of hepatitis B surface antibody was seen at all CD4 counts and viral loads. The multivariate analysis showed only the HIV viral load was predictive of immunologic response. Twenty of the vaccine-eligible patients who did not receive vaccination were infected with HBV during the study period. No vaccinated persons contracted hepatitis B. CONCLUSION Failure to implement these guidelines represents a missed opportunity to prevent disease. In our study, HIV viral load was better than CD4 count as a predictor of response to the HBV vaccination. However, neither low CD4 count nor high HIV viral load should be used as justification to delay vaccination of high-risk persons.
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Affiliation(s)
- Christina L Bailey
- Division of Infectious Diseases, University of Florida Health Science Center, Jacksonville, Florida 32206, USA
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Significance of isolated antibody to hepatitis B core antigen in Dutch national vaccination campaign of behavioural high-risk groups. Epidemiol Infect 2008; 137:495-503. [DOI: 10.1017/s095026880800085x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
SUMMARYIn the Dutch national vaccination campaign for behavioural risk groups, anti-HBcore is used as the primary HBV screening test. Samples with positive results undergo testing for active infection (HBsAg) but are otherwise accepted as indicating past infection, thereby assuming immunity. This study evaluated evidence for immunity in the target population screened on the basis of this algorithm, by re-analysing 1000 anti-HBcore-positive blood samples equally divided among risk groups: 14·7% of confirmed anti-HBcore lacked anti-HBs (‘isolated’ anti-HBcore). Independent risk factors for isolated anti-HBcore were risk group, HCV infection in hard-drug users (DU) and origin from Sub-Saharan Africa. After extrapolation, the proportion of participants who were said to be immune but lacked any additional evidence of immunity amounted to 9·6% (ranging from 12·5% in DU to 6·5% in men who have sex with men). It is recommended that as a minimum anti-HBs screening is included in testing algorithms used to determine vaccination programmes for risk groups, in particular in DU.
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Laguno M, Larrousse M, Luis Blanco J, Leon A, Milinkovic A, Martínez-Rebozler M, Loncá M, Martinez E, Sanchez-Tapias JM, de Lazzari E, Maria Gatell J, Costa J, Mallolas J. Prevalence and clinical relevance of occult hepatitis B in the fibrosis progression and antiviral response to INF therapy in HIV-HCV-coinfected patients. AIDS Res Hum Retroviruses 2008; 24:547-53. [PMID: 18393687 DOI: 10.1089/aid.2007.9994] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Occult hepatitis B virus (HBV) infection is diagnosed when HBc antibodies (HBcAb) and HBV DNA are detectable in serum while hepatitis B surface antigen (HBsAg) is not. This situation has been frequently described in patients with chronic hepatitis C virus (HCV) infection. The objective of this study was to evaluate the prevalence of occult hepatitis B in HIV-HCV-coinfected patients and its clinical relevance in liver histology and viral response after interferon therapy for HCV. A total of 238 HIV-HCV-infected patients,negative for HBsAg, were included. Serum samples were analyzed for the presence of HBV DNA and HBcAb.HBV DNA quantification was determined with the Cobas TaqMan HBV Test (detection limit 6 IU/ml). Data from liver biopsy and laboratory tests were also analyzed. HBcAb resulted in 142 (60%) patients, being the independent associated factors: male gender, previous history of intravenous drug use, age, CD4 count,and HAV antibody presence. Among 90 HBcAb patients that we could analyze, HBV DNA was positive in 15 (16.7% of occult hepatitis B infection in this group, and 6.3% in the whole HIV-HCV cohort studied). No baseline factors, liver histology, or HCV therapy response were related to the presence of HBV DNA. We found that occult hepatitis B is a frequent condition present in at least 6.3% of our HCV-HIV patients and in more than 16% of those with HBcAb. Despite the high prevalence, this phenomenon does not seem to affect the clinical evolution of chronic hepatitis C or modify the viral response to interferon-based HCV therapies
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43
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Servoss JC, Friedman LS. Serologic and molecular diagnosis of hepatitis B virus. Infect Dis Clin North Am 2008; 20:47-61. [PMID: 16527648 DOI: 10.1016/j.idc.2006.01.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Serologic assays for HBV are the mainstay diagnostic tools for HBV infection. However, the advent of molecular biology-based techniques has added a new dimension to the diagnosis and treatment of patients with chronic HBV infection. Over the past decade, improvements in molecular technology, permitting detection of as few as 10 copies/mL of HBV DNA in serum have led to redefinitions of chronic HBV infection, as well as thresholds for antiviral treatment. As the sensitivity of these molecular techniques continues to improve, the challenge will be to standardize these as-says as well as define clinically significant levels of HBV replication.
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Affiliation(s)
- Julie C Servoss
- Department of Medicine, Harvard Medical School, Boston, MA 02114, USA
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Abstract
Persons at high risk for human immunodeficiency virus (HIV) infection are also likely to be at risk for other infectious pathogens, including hepatitis B virus (HBV) or hepatitis C virus (HCV). These are bloodborne pathogens transmitted through similar routes; for example, via injection drug use (IDU), sexual contact, or from mother to child during pregnancy or birth. In some settings, the prevalence of coinfection with HBV and/or HCV is high. In the context of effective antiretroviral therapy (ART), liver disease has emerged as a major cause of morbidity and mortality in HIV-infected persons. Further, coinfection with viral hepatitis may complicate the delivery of ART by increasing the risk of drug-related hepatoxicity and impacting the selection of specific agents (e.g., those dually active against HIV and HBV). Expert guidelines developed in the United States and Europe recommend screening of all HIV-infected persons for infection with HCV and HBV and appropriate management of those found to be chronically infected. Treatment strategies for HBV infection include the use of nucleos(t)ide analogues with or without anti-HIV activity and/or peginterferon alfa (PegIFN) whereas HCV treatment is limited to the combination of PegIFN and ribavirin (RBV). Current approaches to management of HIV-infected persons coinfected with HBV or HCV are discussed in this review.
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Affiliation(s)
- Mark S Sulkowski
- Johns Hopkins University School of Medicine, 600 North Wolfe Street, 1830 Building, Room 448, Baltimore, MD 21287, USA.
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45
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Cheruvu S, Marks K, Talal AH. Understanding the pathogenesis and management of hepatitis B/HIV and hepatitis B/hepatitis C virus coinfection. Clin Liver Dis 2007; 11:917-43, ix-x. [PMID: 17981235 DOI: 10.1016/j.cld.2007.08.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The approach to the hepatitis B virus (HBV)-infected patient who is also infected with HIV or hepatitis C virus (HCV) is very different from the approach to the patient with only one virus infection. HBV/HIV coinfection is common. Agents that have dual activity against HBV and HIV should be considered as treatment of choice in combination regimens in HBV/HIV-coinfected patients beginning antiretroviral therapy. In HBV/HCV coinfection HCV usually tends to predominate over HBV. More investigation is needed into the mechanisms by which viral pathogenesis is altered and the optimal treatment modalities for coinfected patients.
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Affiliation(s)
- Srinivas Cheruvu
- Division of Gastroenterology and Hepatology, Weill Medical College of Cornell University, 525 E. 68th Street, Box 319, New York, NY 10065, USA
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Osborn MK, Guest JL, Rimland D. Hepatitis B virus and HIV coinfection: relationship of different serological patterns to survival and liver disease. HIV Med 2007; 8:271-9. [PMID: 17561872 DOI: 10.1111/j.1468-1293.2007.00469.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Eighty per cent of HIV-positive patients show evidence of past or current infection with hepatitis B virus (HBV). The impact of chronic HBV infection or the presence of isolated HBV core antibody on survival in the era of highly active antiretroviral therapy (HAART) has not been well studied. METHODS This retrospective analysis included patients from the HIV Atlanta Veterans Affairs Cohort Study (HAVACS). This cohort comprises 2818 HIV-positive patients followed since 1982. For this analysis, 1685 patients with available HBV serologies were included, based on laboratory records available since 1992. Adjusted survival analyses were performed for patients showing any of four serological patterns for HBV: (1) surface antigen positive (chronic HBV infection), (2) isolated core antibody, (3) surface antibody with or without core antibody (resolved/vaccinated) and (4) no HBV markers (negative group). Risk factors for liver disease were identified. RESULTS A trend was seen for a lower survival rate from AIDS to death in the chronic HBV infection group compared with the negative group [hazard ratio (HR) 1.43; P=0.118]. The only independent predictor of lower survival rate was hepatitis C virus positivity (HR 1.62; P=0.008). Protective factors were use of HAART (HR 0.40; P=0.0003), use of lamivudine (HR 0.36; P<0.0001) and use of tenofovir (HR 0.23; P<0.0001). Survival from HIV diagnosis to death was not different among the HBV groups. Isolated core antibody patients did not have a lower survival rate compared with those with resolved HBV infection. Patients with chronic HBV infection were 3.5 times more likely to have liver disease than those with no HBV infection (P<0.02). CONCLUSIONS There is a trend towards a lower survival rate in patients with HIV and chronic HBV infection, but the difference did not reach statistical significance. The presence of isolated core antibody was not associated with a lower survival rate.
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Affiliation(s)
- M K Osborn
- School of Medicine, Emory University, Division of Infectious Diseases, Atlanta, GA 30308, USA.
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47
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Thomas-Gosain N, Adeyemi OM. Perceived significance of isolated HBcAb in patients with HIV: a survey of practitioners. AIDS Patient Care STDS 2007; 21:385-9. [PMID: 17594247 DOI: 10.1089/apc.2006.0083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The prevalence of the isolated hepatitis B core Ab phenotype (hepatitis B surface antigen negative [HBsAg-] hepatitis B surface antibody negative [HBsAb-], and hepatitis B core antibody positive [HBcAb+] is particularly high among human HIV-positive patients. Controversy exists regarding both the significance of this phenotype and the risk of progressive liver disease as well as the need for hepatitis B vaccination in this population. A survey of 40 HIV primary care providers (PCPs) at an urban outpatient HIV clinic was conducted in 2005 regarding these two issues and a summary of the findings are presented in this report. Seventy-eight percent thought that these patients' infection had resolved and were immune, half thought they were at risk for progressive liver disease, and 6 (15%) routinely administered hepatitis B vaccine to patients with this phenotype. The wide variety in attitudes and practices among providers in a single clinic suggests the need for further research and development of management guidelines in this group of patients.
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48
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French AL, Operskalski E, Peters M, Strickler HD, Tien PC, Sharp GB, Glesby MJ, Young M, Augenbraun M, Seaberg E, Kovacs A. Isolated hepatitis B core antibody is associated with HIV and ongoing but not resolved hepatitis C virus infection in a cohort of US women. J Infect Dis 2007; 195:1437-42. [PMID: 17436223 PMCID: PMC3133731 DOI: 10.1086/515578] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2006] [Accepted: 12/09/2006] [Indexed: 11/04/2022] Open
Abstract
To characterize predictors of isolated hepatitis B core antibody (anti-HBc) among human immunodeficiency virus (HIV)-infected and HIV-uninfected women, we compared 702 women with anti-HBc and hepatitis B surface antibody (anti-HBs) with 490 women with isolated anti-HBc (1.8% of whom had detectable hepatitis B virus [HBV] DNA). Factors independently associated with isolated anti-HBc without viremia were detectable hepatitis C virus (HCV) RNA, HIV positivity, history of injection drug use, >10 lifetime sex partners, and HIV RNA level >100,000 copies/mL. Anti-HBs levels were lower among anti-HCV-positive women. Isolated anti-HBc was rarely explained by occult HBV in this cohort but may be explained by the influence of viral coinfections on anti-HBs level or durability.
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Affiliation(s)
- Audrey L French
- CORE Center/Stroger (Cook County) Hospital, Rush Medical College, Chicago, IL 60612, USA.
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49
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McGovern BH. The Epidemiology, Natural History and Prevention of Hepatitis B: Implications of HIV Coinfection. Antivir Ther 2007. [DOI: 10.1177/135965350701203s02] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Approximately 350 million people have chronic hepatitis B infection, a leading cause of cirrhosis and hepatocellular carcinoma (HCC). Patients who are infected through parenteral or sexual transmission are also at risk for acquisition of HIV. Concomitant HIV infection can lead to an increased risk of morbidity and mortality from hepatitis B virus (HBV)-related cirrhosis, end-stage liver disease and HCC. This review will focus on the epidemiology, natural history and prevention of HBV infection and the modulating effect of HIV on the clinical expression of HBV disease.
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Affiliation(s)
- Barbara H McGovern
- Division of Infectious Diseases, Tufts University School of Medicine, Boston, MA, USA
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50
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Affiliation(s)
- Anna S F Lok
- Division of Gastroenterology, University of Michigan Medical Center, 3912 Taubman Center, Box 0362, Ann Arbor, MI 48109-0362, USA.
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