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: 1.04). 09/2008; 12(4):300-5. DOI: 10.1590/S1413-86702008000400008
Source: PubMed

ABSTRACT 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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    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; 11:310. · 3.03 Impact Factor
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    ABSTRACT: Background: Hepatitis B virus (HBV) and Hepatitis C virus (HCV) are common nosocomial infections that cause higher rates of mortality and morbidity in maintenance hemodialysis (HD) patients than in the general population. Occult HBV (OHBV) infection is a clinical form of hepatitis B in which, despite the absence of detectable hepatitis B surface antigen (HBsAg) in serum, HBV-DNA is present in both serum and hepatocytes Objective: To determine the prevalence of OHBV infection among HD patients with chronic HCV infection and to compare it with that of HCV-infected patients with normal renal function. Patient and Methods: A total of 32 chronic renal failure patients undergoing maintenance HD (Group1) in the dialysis unit of Nephrology Department at Theodor Bilharz Research Institute (TBRI) Giza, Egypt and 22 chronic HCV patients with normal renal function (Group 2) who were admitted to Gastroenterology Department at TBRI were included in the present study. Serological markers of HBV infection including hepatitis B surface antigen (HBsAg), hepatitis B surface antibodies (anti-HBs), hepatitis B core antibodies (anti-HBc) and anti-HCV antibody were determined using enzyme linked immunoassays. HBV DNA and HCV RNA were detected by polymerase chain reaction. Results: OHBV was detected in 71.9% (23/32) of HD patients compared to 0% in group (2). HBV DNA seropositivity and anti-HBc were significantly higher in Group (1) than in Group (2) (P = 0.005, P = 0.03, respectively). HCV RNA positivity by PCR were significantly higher in patients with chronic HCV infection with normal renal function than in HD ones (P = 0.003). Among patients on maintenance HD, no statistically significant differences were detected regarding duration of HD, history of blood transfusion, biochemical parameters and serological markers between HBV DNA positive patients versus negative ones. Conclusions: The prevalence of occult HBV infection is high in HD patients with chronic HCV infection in our institute suggesting a possible risk of procedure –related infection in HD unit. Sensitive molecular diagnosis of HBV DNA is recommended for patients in addition to routine serological tests.
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    ABSTRACT: Hemodialysis patients potentially have an increased risk of infection with parenterally transmitted viral agents due to an impaired host immune response and multiple transfusion requirements. Viral hepatitis is considered as a problem for hemodialysis patients because 1.9% of all deaths among this population are related to the consequence of viral hepatitis. Hepatitis B virus (HBV) is one of the most important causes of transmitted infections by the parenteral route in hemodialysis patients. Occult HBV infection is characterized by presence of HBV infection without detectable hepatitis B surface antigen (HBsAg), which harbors potential risk of HBV transmission through hemodialysis. There are conflicting reports on the prevalence of occult HBV infection (OBI) in hemodialysis patients. Considering the importance of occult HBV infection in hemodialysis patients and the growing evidence on this subject, the purpose of this review is to provide comprehensive information on OBI prevalence in hemodialysis patients and highlight the most important points in this issue.
    Therapeutic apheresis and dialysis: official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy 08/2012; 16(4):328-33. · 1.53 Impact Factor


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