Hepatitis Virus Diversity Research Programme, Department of Internal Medicine, University of the Witwatersrand, Johannesburg, South Africa.
PLoS One. 2012;7(10):e45750. doi: 10.1371/journal.pone.0045750. Epub 2012 Oct 1.
Hepatitis B virus (HBV) and human immunodeficiency virus (HIV) share transmission routes and are endemic in sub-Saharan Africa. The objective of the present study was to use the Taormina definition of occult HBV infection, together with stringent amplification conditions, to determine the prevalence and characteristics of HBV infection in antiretroviral treatment (ART)-naïve HIV(+ve) adults in a rural cohort in South Africa. The presence of HBV serological markers was determined by enzyme linked immunoassay (ELISA) tests. HBV DNA-positivity was determined by polymerase chain reaction (PCR) of at least two of three different regions of the HBV genome. HBV viral loads were determined by real-time PCR. Liver fibrosis was determined using the aspartate aminotransferase-to-platelet ratio index. Of the 298 participants, 231 (77.5%) showed at least one HBV marker, with 53.7% HBV DNA(-ve) (resolved) and 23.8% HBV DNA(+ve) (current) [8.7% HBsAg(+ve): 15.1% HBsAg(-ve)]. Only the total number of sexual partners distinguished HBV DNA(+ve) and HBV DNA(-ve) participants, implicating sexual transmission of HBV and/or HIV. It is plausible that sexual transmission of HBV and/or HIV may result in a new HBV infection, superinfection and re-activation as a consequence of immunesuppression. Three HBsAg(-ve) HBV DNA(+ve) participants had HBV viral loads <200 IU/ml and were therefore true occult HBV infections. The majority of HBsAg(-ve) HBV DNA(+ve) participants did not differ from HBsAg(+ve) HBV DNA(+ve) (overt) participants in terms of HBV viral loads, ALT levels or frequency of liver fibrosis. Close to a quarter of HIV(+ve) participants were HBV DNA(+ve), of which the majority were HBsAg(-ve) and were only detected using nucleic acid testing. Detection of HBsAg(-ve) HBV DNA(+ve) subjects is advisable considering they were clinically indistinguishable from HBsAg(+ve) HBV DNA(+ve) individuals and should not be overlooked, especially if lamivudine is included in the ART.
乙型肝炎病毒（HBV）和人类免疫缺陷病毒（HIV）具有共同的传播途径，且在撒哈拉以南非洲流行。本研究的目的是使用 Taormina 定义的隐匿性乙型肝炎病毒感染，结合严格的扩增条件，确定南非农村队列中接受抗逆转录病毒治疗（ART）的 HIV（+ve）初治成年人中的 HBV 感染率和特征。通过酶联免疫吸附试验（ELISA）检测 HBV 血清学标志物。通过聚合酶链反应（PCR）检测 HBV 基因组的至少三个不同区域的 HBV DNA 阳性。通过实时 PCR 检测 HBV 病毒载量。使用天门冬氨酸氨基转移酶-血小板比值指数（APRI）检测肝纤维化。在 298 名参与者中，231 名（77.5%）至少有一个 HBV 标志物，其中 53.7% HBV DNA（-ve）（已解决）和 23.8% HBV DNA（+ve）（当前）[8.7% HBsAg（+ve）：15.1% HBsAg（-ve）]。只有性伴侣总数能区分 HBV DNA（+ve）和 HBV DNA（-ve）参与者，这暗示 HBV 和/或 HIV 通过性传播。性传播 HBV 和/或 HIV 可能导致新的 HBV 感染、合并感染和免疫抑制后的再激活。3 名 HBsAg（-ve）HBV DNA（+ve）的参与者 HBV 病毒载量<200 IU/ml，因此属于真正的隐匿性 HBV 感染。大多数 HBsAg（-ve）HBV DNA（+ve）参与者在 HBV 病毒载量、ALT 水平或肝纤维化频率方面与 HBsAg（+ve）HBV DNA（+ve）（显性）参与者没有差异。近四分之一的 HIV（+ve）参与者 HBV DNA（+ve），其中大多数为 HBsAg（-ve），仅通过核酸检测检测到。鉴于 HBsAg（-ve）HBV DNA（+ve）患者在临床上与 HBsAg（+ve）HBV DNA（+ve）患者无法区分，且如果拉米夫定包含在 ART 中，他们不应被忽视，因此建议检测 HBsAg（-ve）HBV DNA（+ve）患者。
