Hofer M, Joller-Jemelka H I, Grob P J, Lüthy R, Opravil M
Division of Infectious Diseases and Hospital Epidemiology, University Hospital, Zurich, Switzerland.
Eur J Clin Microbiol Infect Dis. 1998 Jan;17(1):6-13. doi: 10.1007/BF01584356.
Persons with immune deficiency may present with atypical results in serological tests for hepatitis B virus (HBV). Frozen serum specimens that were sequentially obtained over time from a cohort of 57 HIV-infected patients, all of whom tested positive only for antibody to hepatitis B core antigen (anti-HBcAg), were therefore retested for HBV markers, including HBV DNA. The results were assessed for their time course and correlated with clinical data and alanine aminotransferase (ALT) values. Forty-eight patients were male; intravenous drug users constituted the principal risk group (n = 30), followed by homosexual men (n = 22). Thirty-three persons tested positive for antibody to hepatitis C virus (anti-HCV). During a median of 31 months from the first to the last serum, anti-HBcAg remained the sole marker of HBV infection in 98.2% of the patients. Polymerase chain reaction (PCR) to detect DNA for HBV core and HBV surface gene was positive in 126 (62.4%) and 121 (59.9%) of all 202 serum samples, respectively. Over time, HBV DNA was detected at least once in 51 (89.5%) patients. In contrast, decomplexed hepatitis B surface antigen (HBsAg) was detected at least once in 14 (24.6%) patients. Among patients positive for HBV DNA and negative for anti-HCV, eight (36.4%) of 22 had chronic hepatitis (ALT elevation > or = 6 months) that was attributable only to persisting HBV infection. Similarly, 12 (41.4%) of 29 patients positive for both HBV DNA and anti-HCV had chronic viral hepatitis, but their ALT values were significantly higher. In HIV-infected patients, anti-HBcAg as the sole serological HBV marker detected must be considered indicative of chronic HBV infection and is in part associated with chronic hepatitis and ALT elevation.
免疫缺陷患者在乙肝病毒（HBV）血清学检测中可能出现非典型结果。因此，对一组57例HIV感染患者随时间顺序采集的冷冻血清标本重新进行了HBV标志物检测，包括HBV DNA，这些患者均仅乙肝核心抗原抗体（抗-HBcAg）检测呈阳性。评估结果的时间进程，并将其与临床数据及丙氨酸转氨酶（ALT）值进行关联分析。48例患者为男性；主要风险人群为静脉吸毒者（n = 30），其次为男同性恋者（n = 22）。33人丙肝病毒抗体（抗-HCV）检测呈阳性。从首次采集血清到最后一次采集血清的中位时间为31个月，98.2%的患者中抗-HBcAg仍是HBV感染的唯一标志物。在所有202份血清样本中，检测HBV核心DNA和HBV表面基因的聚合酶链反应（PCR）分别有126份（62.4%）和121份（59.9%）呈阳性。随着时间推移，51例（89.5%）患者至少有一次检测到HBV DNA。相比之下，14例（24.6%）患者至少有一次检测到去复合乙肝表面抗原（HBsAg）。在HBV DNA阳性且抗-HCV阴性的患者中，22例中有8例（36.4%）患有仅由持续HBV感染引起的慢性肝炎（ALT升高≥6个月）。同样，在HBV DNA和抗-HCV均阳性的29例患者中，12例（41.4%）患有慢性病毒性肝炎，但其ALT值显著更高。在HIV感染患者中，仅检测到抗-HBcAg作为唯一血清学HBV标志物时，必须考虑其提示慢性HBV感染，且部分与慢性肝炎和ALT升高有关。
