Nebbia Gaia, Garcia-Diaz Ana, Ayliffe Ursula, Smith Colette, Dervisevic Samir, Johnson Margaret, Gilson Richard, Tedder Richard, Geretti Anna Maria
Department of Virology, Royal Free Hospital and Royal Free & University College Medical School, London, UK.
J Med Virol. 2007 Oct;79(10):1464-71. doi: 10.1002/jmv.20954.
It has been proposed that occult hepatitis B virus (HBV) infection, defined as detectable HBV-DNA in serum with undetectable surface antigen (HBsAg(-)), is associated with raised transaminases in HIV-infected persons. The aim of this study was to determine the prevalence of occult HBV infection in two independent cohorts, and investigate its predictors, association with alanine-aminotransferase (ALT) levels and response to antiretroviral therapy. Sera from HBsAg(-) persons with core antibody (anti-HBc(+)) were tested by real-time PCR. Overall, 5.2% of patients were HBsAg(+) and 39% HBsAg(-)/anti-HBc(+). The prevalence of occult HBV infection was 48/343 (14.0%; 95% CI 10.7-18.1%), and 27/196 (13.8%) and 21/147 (14.3%) in the two cohorts. Median HBV-DNA load was 342 (51-147,500) and 60 (25-33,850) copies/ml respectively. HBV-DNA detection was associated with absence of surface antibody (anti-HBs), but not with CD4 or ALT levels. Among 11 HBV-DNA(+) persons who started antiretroviral therapy containing lamivudine or lamivudine/tenofovir, HBV-DNA was repeatedly undetectable over median 19 (3-43) months. However, HBV-DNA detection was intermittent among drug-naïve persons. Occult HBV infection is common in HBsAg(-)/anti-HBc(+) HIV-infected patients and predicted by undetectable anti-HBs. The intermittent nature of HBV-DNA detection poses a diagnostic challenge, but no association is observed with ALT levels.
有人提出，隐匿性乙型肝炎病毒（HBV）感染（定义为血清中可检测到HBV-DNA但表面抗原检测不到（HBsAg(-)））与HIV感染者转氨酶升高有关。本研究的目的是确定两个独立队列中隐匿性HBV感染的患病率，并调查其预测因素、与丙氨酸转氨酶（ALT）水平的关联以及对抗逆转录病毒治疗的反应。通过实时PCR检测HBsAg(-)且核心抗体阳性（抗-HBc(+)）者的血清。总体而言，5.2%的患者HBsAg(+)，39%的患者HBsAg(-)/抗-HBc(+)。隐匿性HBV感染的患病率在两个队列中分别为48/343（14.0%；95%CI 10.7-18.1%）、27/196（13.8%）和21/147（14.3%）。HBV-DNA载量中位数分别为342（51-147,500）和60（25-33,850）拷贝/ml。HBV-DNA检测与表面抗体（抗-HBs）缺失有关，但与CD4或ALT水平无关。在11名开始接受含拉米夫定或拉米夫定/替诺福韦的抗逆转录病毒治疗的HBV-DNA(+)患者中，中位数19（3-43）个月期间HBV-DNA反复检测不到。然而，在未接受过治疗的患者中，HBV-DNA检测呈间歇性。隐匿性HBV感染在HBsAg(-)/抗-HBc(+)的HIV感染患者中很常见，且可通过检测不到抗-HBs来预测。HBV-DNA检测的间歇性对诊断构成挑战，但未观察到与ALT水平有关联。
