Longitudinal evaluation of occult Hepatitis B infection in HIV-1 infected individuals during highly active antiretroviral treatment interruption and after HAART resumption

[Guest guest]

http://www.springerlink.com/content/w4t043832223238k/

Infection

DOI: 10.1007/s15010-011-0093-9Online FirstT

Clinical and Epidemiological Study

Longitudinal evaluation of occult Hepatitis B infection in HIV-1 infected

individuals during highly active antiretroviral treatment interruption and after

HAART resumption

S. Bagaglio, G. Bianchi, A. Danise, L. Porrino, C. Uberti-Foppa, A. Lazzarin, A.

Castagna and G. Morsica

Abstract

Background and objective

The prevalence and clinical significance of overt hepatitis B (OHB) in human

immunodeficiency virus (HIV)-infected individuals and the effect of HAART on

this cryptic infection remain controversial. We have investigated the potential

effect of the interruption and subsequent re-introduction of highly active

antiretroviral therapy (HAART) on the frequency and dynamics of OHB in

HIV-infected individuals.

Study design

This pilot study involved 29 HIV-infected individuals who tested positive for HB

anti-core antibodies in the absence of surface antigen during a 100-week period

(48-week-long interruption of HAART or lamivudine monotherapy plus 52 weeks of

follow-up prior to HAART resumption). The frequency and dynamics of OHB were

assessed by means of qualitative detection tests and quantification in the

plasma. Resistance to HBV was determined by direct sequence analysis of the

polymerase gene.

Results

Of the 29 HIV-infected individuals enrolled in the study, nine (31%) showed

signs of OHB during the 100-week study period: three patients showed

intermittent HB virus (HBV)-DNAemia, while six patients were HBV-DNA positive

only at 16 weeks following HAART resumption. The HBV-DNA load invariably fell

below the sensitivity of the quantitative test (103 copies/mL). The HIV-related

immuno-virologic profile and biochemical parameters, including hepatic

transaminases, of patients with at least one HBV-DNA positive test result were

not significant different from those of individuals who consistently tested

negative for HBV-DNA. The only significant parameter was a lower median change

(Ä1) in the CD4+/CD8+ ratio (p = 0.038) in occult HBV cases compared to

non-occult cases, between the HAART re-introduction time point and baseline.

Conclusions

The intermittent nature of HBV-DNAemia poses a diagnostic challenge, but no

association was found with transaminase levels at any time.