Firnhaber Cynthia, Viana Raquel, Reyneke Anne, Schultze Doreen, Malope Babatyi, Maskew Mhairi, Di Bisceglie Adrian, MacPhail Patrick, Sanne Ian, Kew Michael
Clinical HIV Research Unit, Department of Medicine, University of the Witwatersrand, Johannesburg, South Africa.
Int J Infect Dis. 2009 Jul;13(4):488-92. doi: 10.1016/j.ijid.2008.08.018. Epub 2008 Dec 9.
The prevalence of HIV/hepatitis B virus (HBV) co-infection in South Africa ranges from 4.8% to 17% using the standard marker surface antigen (hepatitis B surface antigen, HBsAg) for chronic active HBV infection. However, sensitive molecular techniques for detecting HBV DNA in serum can detect occult HBV infection. We report the first observational prospective study of occult HBV infection in HIV-positive people in South Africa.
Five hundred and two patients attending an urban hospital were screened for HBV using serological testing for HBsAg, core antibody (anti-HBc), and surface antibody (anti-HBs). DNA was analyzed using real-time quantitative PCR to determine the HBV viral load.
Of the 502 participants, 24 (4.8%) were HBsAg-positive and 53 (10.6%) were positive for anti-HBc alone. Of these 53, screening for occult disease was carried out in 43, of whom 38 (88.4%) were positive. The mean HBV viral load was 2.8 x 10(4) copies/ml (range 1 x 10(2) to 1 x 10(6) copies/ml).
Combining the participants with positive HBsAg and occult HBV DNA results, the prevalence of HBV increases from 4.8% (HBsAg alone) to 12.4%. While the clinical impact of occult HBV infection is unclear, consideration should be given to changing the guidelines to recommend dual HBV therapy for the treatment of co-infected patients in the developing world.
在南非，使用慢性活动性乙肝病毒（HBV）感染的标准标志物表面抗原（乙肝表面抗原，HBsAg）检测发现，HIV/乙肝病毒（HBV）合并感染率为4.8%至17%。然而，用于检测血清中HBV DNA的敏感分子技术可检测到隐匿性HBV感染。我们报告了南非首例关于HIV阳性人群隐匿性HBV感染的观察性前瞻性研究。
对一家城市医院的502名患者进行了HBV筛查，采用HBsAg、核心抗体（抗-HBc）和表面抗体（抗-HBs）的血清学检测。使用实时定量PCR分析DNA以确定HBV病毒载量。
在502名参与者中，24人（4.8%）HBsAg呈阳性，53人（10.6%）仅抗-HBc呈阳性。在这53人中，对43人进行了隐匿性疾病筛查，其中38人（88.4%）呈阳性。HBV病毒载量的平均值为2.8×10⁴拷贝/毫升（范围为1×10²至1×10⁶拷贝/毫升）。
将HBsAg阳性和隐匿性HBV DNA结果的参与者合并计算，HBV感染率从4.8%（仅HBsAg）增至12.4%。虽然隐匿性HBV感染的临床影响尚不清楚，但在发展中国家，应考虑改变指南，推荐对合并感染患者采用双重HBV治疗。
