Occult hepatitis B virus infection in immunocompromised patients

Study Group of Hepatitis, Infectious Disease, Department of Clinical Medicine, Faculty of Medical Science, State University of Campinas, São Paulo, SP, Brazil.
The Brazilian journal of infectious diseases: an official publication of the Brazilian Society of Infectious Diseases (Impact Factor: 1.3). 09/2008; 12(4):300-5. DOI: 10.1590/S1413-86702008000400008
Source: PubMed


Occult hepatitis B infection is characterized by hepatitis B virus (HBV) DNA in the serum in the absence of hepatitis B surface antigen (HBsAg). We assessed occult HBV infection prevalence in two groups of immunocompromised patients (maintenance hemodialysis patients and HIV-positive patients) presenting HBsAg-negative and anti-HBc positive serological patterns, co-infected or not by HCV. Thirty-four hemodialysis anti-HIV negative patients, 159 HIV-positive patients and 150 blood donors who were anti-HBc positive (control group) were selected. HBV-DNA was detected by nested-PCR. Occult hepatitis B infection was not observed in the hemodialysis patients group but was found in 5% of the HIV-patients and in 4% of the blood donors. Immunosuppression in HIV positive patients was not a determining factor for occult HBV infection. In addition, no significant relationship between HBV-DNA and HCV co-infection in the HIV-positive patient group was found. A lack of significant associations was also observed between positivity for HBV-DNA and CD4 count, viral load and previous lamivudine treatment in these HIV-positive patients.

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Available from: Neiva Sellan Lopes Gonçales, Oct 13, 2014
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    • "Isolated anti-HBV core antibodies (anti-HBc) have been shown to be a predictive marker of OBI [2]. Isolated anti-HBc [3,4] and OBI are often seen in patients with human immunodeficiency virus (HIV) infection [5,6], where they are more prevalent than in non-coinfected individuals [7]. Reactivation of chronic HBV in presence of HBsAg has been reported in immunosuppressed subjects and in those with HIV infection following discontinuation of antiretroviral therapy (ART) [8,9]. "
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    ABSTRACT: Occult hepatitis B virus (HBV) infection (OBI) is characterized by HBV DNA persistence even though the pattern of serological markers indicates an otherwise resolved HBV infection. Although OBI is usually clinically silent, immunocompromised patients may experience reactivation of the liver disease. We report the case of an individual with human immunodeficiency virus (HIV) infection and anti-HBV core antibody positivity, who experienced severe HBV reactivation after discontinuation of lamivudine-including antiretroviral therapy (ART). HBV sequencing analysis showed a hepatitis B surface antigen escape mutant whose presence in an earlier sample excluded reinfection. Molecular sequencing showed some differences between two isolates collected at a 9-year interval, indicating HBV evolution. Resumption of ART containing an emtricitabine/tenofovir combination allowed control of plasma HBV DNA, which fell to undetectable levels. This case stresses the ability of HBV to evolve continuously, even during occult infection, and the effectiveness of ART in controlling OBI reactivation in HIV-infected individuals.
    BMC Infectious Diseases 11/2011; 11(1):310. DOI:10.1186/1471-2334-11-310 · 2.61 Impact Factor
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    • "Some of the patients do not have detectable HBV-DNA in serum, despite the presence of HBV-DNA in hepatocytes [2]. Furthermore, high prevalence rates of OBI in chronic HCV-infected patients [3], hemodialysis patients [1][4], immunocompromised patients [5] and HIV-infected patients [6] have been reported. OBI is clinically important because it may induce chronic liver disease [2] and cryptogenic cirrhosis [7]. "
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    ABSTRACT: Occult hepatitis B infection (OBI) is a form of hepatitis in which there is an absence of detectable HBsAg, despite the presence of HBV-DNA in the peripheral blood of patients. It seems that non-effective or attenuated immune system responses against HBV lead to the development of OBI. Previous studies showed that the Fas/Fas ligand (FasL) system is an important death signaling pathway that is used by cytotoxic T lymphocytes to eradicate HBV from the liver. To investigate polymorphisms in the -670 region of the Fas gene in those with OBI. The plasma samples from 3700 blood donors were tested for HBsAg and anti-HBs by ELISA. The HBsAg-/anti-HBc(+) samples were selected and screened for HBV-DNA by PCR. Those with HBV-DNA were diagnosed as OBI and PCR-RFLP technique was performed to examine polymorphisms within their Fas gene. 352 (9.5%) of 3700 blood samples were HBsAg-/anti-HBc(+). HBV-DNA was detected in 57 (16.1%) of 352 HBsAg-/anti-HBc(+) samples. Therefore, 57 HBsAg-/anti-HBc+/HBV-DNA(+) patients were diagnosed as OBI. Patient and control groups had no significant differences in terms of the studied polymorphisms. The functional polymorphisms in the promoter region of Fas gene are not associated with OBI. Therefore, it may be concluded that polymorphisms at the -670 position of the Fas gene do not have any critical effects on the immune response against HBV in OBI.
    Hepatitis Monthly 01/2011; 11(1):23-6. · 1.93 Impact Factor
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    • "In another study in Iran HBV-DNA was detectable in 16.7% of HCV-HIV co-infected patients with isolated anti-HBc [59]. Despite the reports regarding to strong association between HCV infection and OBI [58][60][61][62], Jardim, et al. [40] reported no significant difference in the presence of HBV-DNA in HIV-positive patients with or without HCV infection. Daza, et al. [63] also found a very low rate of HBV-DNA in HIV-HCV co-infected patients. "
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    ABSTRACT: Human immunodeficiency virus (HIV)- infected patients are at risk of acquiring viral hepatitis, due to common routes of transmission. As the introduction of highly active antiretroviral therapy (HAART) reduced the frequency of opportunistic infections and improved survival, viral hepatitis emerged as an important cause of morbidity and mortality in HIV-infected cases. Occult hepatitis B virus (HBV) infection is characterized by presence of HBV infection without detectable hepatitis B surface antigen (HBsAg). There are conflicting reports on the impact of occult HBV infection on the natural history of HIV disease. In this review, we described the findings of studies on HIV and hepatitis B co-infection with focus on the prevalence of occult HBV infection. The results of this review demonstrated the importance of prevention, diagnosis and treatment of occult HBV infection in HIV-positive patients.
    Hepatitis Monthly 01/2011; 11(1):7-10. · 1.93 Impact Factor
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