Dept. of Infectious Diseases, S. Raffaele Scientific Institute, Milan, Italy.
Infection. 2009 Oct;37(5):445-9. doi: 10.1007/s15010-008-8194-9. Epub 2009 Aug 7.
An evaluation of the prevalence of occult hepatitis B virus (HBV) infection in HIV-positive individuals is important as HBV infection may have an impact on the outcome of the liver disease in these patients.
Of the 1,593 HIV-positive subjects enrolled in the Italian Cohort Naïve Antiretroviral (ICONA) program, 175 (10.9%) were selected for inclusion in the study on the basis of hepatitis B surface antigen (HBsAg) negativity and antibody to hepatitis B core antigen (anti- HBc) positivity; 101/175 (58%) were also anti-hepatitis C virus (HCV) positive. HBV-DNA was detected in plasma using a highly sensitive PCR assay (detection limit: 2.6 copies/ml). Two different genomic regions were assayed. Quantification was performed by real-time PCR. The HBV genotype was determined in 20 cases with occult HBV infection. Data on the antiretroviral therapy (ART) regimen was obtained in 169 individuals: 53 (31.4%) patients were ART-naive, 46 (27.2%) were under ART without lamivudine or tenofovir, and the remaining 70 (41.4%) were under ART including lamivudine or tenofovir.
27/175 (15%) patients had detectable HBV-DNA in their plasma: 21/101 (21%) were anti-HCV positive and 6/74 (8%) were anti-HCV negative. Genotype D was invariably found in the 20 cases analyzed. Occult HBV infection was significantly higher in HCV-coinfected subjects: adjusted OR 5.02, 95% CI 1.31-19.26, p = 0.02. The value was not associated with immune status, HIV load, or ART regimen.
In relation to the high prevalence of occult HBV infection, particularly in HIV/HCV-coinfected individuals, it is necessary to clarify the clinical impact of this cryptic infection by monitoring HBV-DNA in plasma using the correct approach. Similarly to HBsAg-positive individuals of the Mediterranean area, HBV genotype D is invariably detected in this cohort of HIV-infected patients with occult HBV infection.
评估 HIV 阳性个体中隐匿性乙型肝炎病毒 (HBV) 感染的流行情况非常重要，因为 HBV 感染可能会对这些患者的肝病结局产生影响。
在意大利 ICONA 初治抗逆转录病毒（ICONA）方案中纳入的 1593 名 HIV 阳性受试者中，根据乙型肝炎表面抗原（HBsAg）阴性和乙型肝炎核心抗原抗体（抗-HBc）阳性，选择了 175 名（10.9%）受试者纳入本研究；其中 101 名（58%）受试者也为抗丙型肝炎病毒（HCV）阳性。使用高度敏感的 PCR 法（检测限：2.6 拷贝/ml）检测血浆中的 HBV-DNA。检测了两个不同的基因组区域。通过实时 PCR 进行定量。对 20 例隐匿性 HBV 感染患者进行 HBV 基因型检测。在 169 名患者中获得了抗逆转录病毒治疗（ART）方案的数据：53 名（31.4%）患者为 ART 初治患者，46 名（27.2%）患者在未接受拉米夫定或替诺福韦的情况下接受 ART，其余 70 名（41.4%）患者接受包含拉米夫定或替诺福韦的 ART。
175 名患者中有 27 名（15%）患者的血浆中可检测到 HBV-DNA：101 名患者中有 21 名（21%）抗-HCV 阳性，74 名患者中有 6 名（8%）抗-HCV 阴性。分析的 20 例患者均发现基因型 D。HCV 合并感染患者隐匿性 HBV 感染明显更高：调整后的比值比为 5.02，95%CI 为 1.31-19.26，p=0.02。该比值与免疫状态、HIV 载量或 ART 方案无关。
鉴于隐匿性 HBV 感染的高流行率，特别是在 HIV/HCV 合并感染患者中，有必要通过使用正确的方法检测血浆中的 HBV-DNA 来明确这种隐匿性感染的临床影响。与地中海地区 HBsAg 阳性者一样，在本队列 HIV 感染的隐匿性 HBV 感染患者中始终检测到 HBV 基因型 D。
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