Division of Clinical Microbiology, Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi-110029, India.
BMC Infect Dis. 2010 Mar 7;10:53. doi: 10.1186/1471-2334-10-53.
Co-infections of hepatitis B and C viruses are frequent with HIV due to shared routes of transmission. In most of the tertiary care health settings, HIV reactive patients are routinely tested for HBsAg and anti-HCV antibodies to rule out these co-infections. However, using the routine serological markers one can only detect active HBV infection while the occult HBV infection may be missed. There is insufficient data from India on HIV-HBV co-infection and even scarce on occult HBV infection in this group.
We estimated the burden of HBV infection in patients who were tested positive for HIV at a tertiary care centre in north India. We also attempted to determine the prevalence and clinical characteristics of occult HBV infection among these treatment-naïve patients and compare their demographic features with other HIV patients. During a period of 6 years between January 2002 to December 2007, 837 HIV positive patients (631 males and 206 females (M: F :: 3.06:1) were tested for serological markers of HBV (HBsAg) and HCV (anti-HCV antibodies) infections in our laboratory. For comparison 1000 apparently healthy, HIV-negative organ donors were also included in the study. Data on demographics, sexual behaviour, medical history, laboratory tests including the serum ALT and CD4 count of these patients were recorded. A sub-group of 53 HBsAg negative samples from HIV positive patients were assessed for anti-HBs, anti-HBc total (IgG+IgM) and HBV-DNA using a highly sensitive qualitative PCR and analysed retrospectively.
Overall, 7.28% of HIV positive patients showed presence of HBsAg as compared to 1.4% in the HIV negative control group. The prevalence of HBsAg was higher (8.55%) in males than females (3.39%). The study revealed that occult HBV infection with detectable HBV-DNA was prevalent in 24.5% of patients positive for anti-HBc antibodies; being 45.5% in HBsAg negative patients. Most importantly the occult infection was seen in 20.7% patients who were positive for anti-HBs antibodies. However, in none of the seronegative patient HBV-DNA was detected. Five of the nine HBV-DNA positive (55.6%) patients showed raised alanine aminotransferase levels and 66.7% had CD4+ T cell counts below 200 cells/cumm.
High prevalence of HIV-HBV co-infection was found in our patients. A sizeable number of co-infected patients remain undiagnosed, if only conventional serological markers are used. Presence of anti-HBs antibodies was not a reliable surrogate marker to rule out occult HBV infection. The most reliable method to diagnose occult HBV co-infection in HIV seropositive patients is the detection of HBV-DNA.
由于乙型肝炎和丙型肝炎病毒传播途径相同，乙型肝炎和丙型肝炎病毒的合并感染在 HIV 患者中很常见。在大多数三级保健医疗机构中，通常会对 HIV 反应性患者进行 HBsAg 和抗-HCV 抗体检测，以排除这些合并感染。然而，仅使用常规血清学标志物，只能检测到活跃的 HBV 感染，而可能会漏检隐匿性 HBV 感染。印度有关 HIV-HBV 合并感染的数据不足，甚至在该人群中隐匿性 HBV 感染的数据也很少。
我们在印度北部的一家三级保健中心估计了 HIV 检测呈阳性的患者中 HBV 感染的负担。我们还试图确定这些未经治疗的患者中隐匿性 HBV 感染的流行率和临床特征，并将其与其他 HIV 患者的特征进行比较。在 2002 年 1 月至 2007 年 12 月期间的 6 年期间，我们实验室对 837 名 HIV 阳性患者（631 名男性和 206 名女性（M：F :: 3.06:1））进行了乙型肝炎病毒（HBsAg）和丙型肝炎病毒（抗-HCV 抗体）血清学标志物检测。为了比较，我们还将 1000 名明显健康、HIV 阴性的器官供者纳入了研究。记录了这些患者的人口统计学特征、性行为、病史、实验室检查（包括血清 ALT 和 CD4 计数）。对 53 名来自 HIV 阳性患者的 HBsAg 阴性样本进行了抗-HBs、抗-HBc 总抗体（IgG+IgM）和 HBV-DNA 的检测，使用高灵敏度的定性 PCR 进行评估，并进行回顾性分析。
总体而言，与 HIV 阴性对照组的 1.4%相比，7.28%的 HIV 阳性患者存在 HBsAg。男性的 HBsAg 患病率（8.55%）高于女性（3.39%）。研究表明，在抗-HBc 抗体阳性的患者中，隐匿性 HBV 感染伴可检测的 HBV-DNA 的患病率为 24.5%；在 HBsAg 阴性患者中为 45.5%。最重要的是，在 20.7%的抗-HBs 抗体阳性患者中发现了隐匿性感染。然而，在所有血清学阴性的患者中均未检测到 HBV-DNA。9 例 HBV-DNA 阳性患者中有 5 例（55.6%）丙氨酸氨基转移酶水平升高，66.7%的患者 CD4+T 细胞计数低于 200 个/cumm。
我们的患者中发现了 HIV-HBV 合并感染的高患病率。如果仅使用常规血清学标志物，则大量合并感染的患者仍未被诊断出来。抗-HBs 抗体的存在并不是排除隐匿性 HBV 感染的可靠替代标志物。诊断 HIV 血清阳性患者隐匿性 HBV 合并感染的最可靠方法是检测 HBV-DNA。
