Department of Medical Virology, University of Pretoria/ Tshwane Academic Division National Health Laboratory Service, Pretoria, South Africa.
S Afr Med J. 2012 Feb 23;102(3 Pt 1):157-62. doi: 10.7196/samj.4944.
As sub-Saharan Africa is highly endemic for hepatitis B virus (HBV) and human immunodeficiency virus (HIV) infections, and their co-infection requires special management, we aimed to assess the serological and molecular characteristics of HBV in patients with AIDS.
This was a cross-sectional, case control study, which enrolled 200 patients with AIDS and 200 HIV-negative controls. HBV serology was done in all participants and HCV serology in participants with a hepatitis B core antibody (anti-HBc) only serological pattern. Nested HBV polymerase chain reaction (PCR) and HBV viral load assays were used for HBV molecular detection.
Hepatitis B surface antigen (HBsAg) prevalence was 3-fold higher while the 'anti-HBc only' pattern was 6-fold higher in the AIDS group compared with the controls. Mean HBV viral load was significantly higher in HBsAg-positive patients with CD4+ cell counts <100 cells/μl than in patients with CD4+ cell counts of 100-200 cells/μl (p=0.019). There were markedly reduced hepatitis B surface antibody (anti-HBs) titres in the AIDS group compared with the controls (p=0.002). A significant proportion of AIDS patients with an 'anti-HBc only' pattern had CD4+ cell counts <100 cells/μl (p=0.004). Occult HBV prevalence was 3.5% in the AIDS group compared with 1% in the controls (p=0.092). When occult HBV infection was taken into consideration, the overall HBV prevalence became 10% in the AIDS group and 3% in the control group.
We showed an increased HBV prevalence in patients with AIDS and identified a CD4+ cell count <100 cells/μl as a major risk factor for the 'anti-HBc only' pattern and increased HBV replication. These data have significant public health implications for HBV in developing countries, especially in areas where antiretroviral (ARV) guidelines do not cater for HBV/HIV co-infection.
由于撒哈拉以南非洲地区乙型肝炎病毒（HBV）和人类免疫缺陷病毒（HIV）感染高度流行，且两者合并感染需要特殊管理，我们旨在评估艾滋病患者中乙型肝炎病毒的血清学和分子特征。
这是一项横断面病例对照研究，共纳入 200 例艾滋病患者和 200 例 HIV 阴性对照者。所有参与者均进行 HBV 血清学检查，仅出现乙型肝炎核心抗体（抗-HBc）血清学模式者进行 HCV 血清学检查。采用巢式 HBV 聚合酶链反应（PCR）和 HBV 病毒载量检测进行 HBV 分子检测。
与对照组相比，艾滋病组乙型肝炎表面抗原（HBsAg）的流行率增加了 3 倍，而“仅抗-HBc”模式增加了 6 倍。HBV 表面抗原阳性且 CD4+细胞计数＜100 个/μl 的患者的 HBV 病毒载量明显高于 CD4+细胞计数为 100-200 个/μl 的患者（p=0.019）。与对照组相比，艾滋病组乙型肝炎表面抗体（抗-HBs）的滴度显著降低（p=0.002）。相当一部分“仅抗-HBc”模式的艾滋病患者的 CD4+细胞计数＜100 个/μl（p=0.004）。艾滋病组隐匿性 HBV 的流行率为 3.5%，对照组为 1%（p=0.092）。考虑到隐匿性 HBV 感染，艾滋病组的总 HBV 流行率为 10%，对照组为 3%。
我们发现艾滋病患者的 HBV 流行率增加，并确定 CD4+细胞计数＜100 个/μl 是“仅抗-HBc”模式和 HBV 复制增加的主要危险因素。这些数据对发展中国家的 HBV 具有重要的公共卫生意义，特别是在抗逆转录病毒（ARV）指南未涵盖 HBV/HIV 合并感染的地区。
