Laboratory of Virology, Grenoble University Hospital, Grenoble, France.
J Med Virol. 2010 May;82(5):747-54. doi: 10.1002/jmv.21695.
The prevalence of occult hepatitis B, defined by absence of HBsAg and HBV DNA, ranges widely in patients with hepatitis C. This may influence the treatment of hepatitis C and the severity of liver disease. Sensitive and specific real-time PCR techniques are available commercially and can detect more reliably low HBV DNA levels. The aim of this study was to determine the prevalence of occult hepatitis B virus infection using the COBAS Taqman assay (Roche Diagnostics, Meylan, France) in the serum and liver of HBsAg negative patients with chronic hepatitis C and to evaluate its clinical consequences on liver pathology and its impact on the response to treatment with peg-IFNalpha and Ribavirin. HBV DNA detection was assessed retrospectively on 140 sera and 113 liver biopsies of HCV positive/HBsAg negative patients before treatment. A 4.4% (5/113) prevalence of occult hepatitis B was recorded in liver samples and in none of the sera. Anti-HBc was not detected in one, three of whom were sustained virological responders to treatment, one was relapsed responder and one was non-responder. Furthermore, in this cohort composed of 12% anti-HBs negative/anti-HBc positive and 20% anti-HBs positive/anti-HBc positive patients, anti-HBc was not associated with pre-therapeutic viral load, ALT serum levels, and histological activity or fibrosis. Using a commercial real-time PCR assay, we observed a low prevalence of occult B hepatitis. This, just as anti-HBC status, had no clinical impact in a large cohort of hepatitis C patients. It therefore does not appear useful to screen for occult hepatitis B in these patients with this test before beginning HCV treatment.
隐匿性乙型肝炎的流行率，定义为 HBsAg 和 HBV DNA 均阴性，在丙型肝炎患者中差异很大。这可能会影响丙型肝炎的治疗和肝脏疾病的严重程度。目前已有商业化的敏感和特异的实时 PCR 技术，可更可靠地检测到低水平的 HBV DNA。本研究旨在使用 COBAS Taqman 检测（罗氏诊断，梅兰，法国）检测 HBsAg 阴性慢性丙型肝炎患者血清和肝组织中隐匿性乙型肝炎病毒感染的流行率，并评估其对肝组织病理学的临床后果及其对聚乙二醇干扰素α和利巴韦林治疗反应的影响。在治疗前，对 140 份血清和 113 份肝活检样本进行了 HBV DNA 的回顾性检测。在肝组织样本中，有 4.4%（5/113）记录到隐匿性乙型肝炎，而在血清样本中均未检测到。有一例未检测到抗-HBc，其中三例对治疗有持续病毒学应答，一例复发应答，一例无应答。此外，在由 12%抗-HBs 阴性/抗-HBc 阳性和 20%抗-HBs 阳性/抗-HBc 阳性患者组成的这一组中，抗-HBc 与治疗前病毒载量、ALT 血清水平以及组织学活动或纤维化无关。使用商业实时 PCR 检测，我们观察到隐匿性乙型肝炎的低流行率。与抗-HBC 状态一样，在丙型肝炎患者的大样本中，这对临床没有影响。因此，在开始丙型肝炎治疗之前，用该检测筛查这些患者的隐匿性乙型肝炎似乎没有用处。
