Development of chronic hepatitis B virus infection in hepatitis B surface antigen negative HIV/HBV co-infected adults: A rare opportunistic illness

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http://www.ncbi.nlm.nih.gov/pubmed/21739443

J Med Virol. 2011 Sep;83(9):1537-43. doi: 10.1002/jmv.22155.

Development of chronic hepatitis B virus infection in hepatitis B surface

antigen negative HIV/HBV co-infected adults: A rare opportunistic illness.

Landrum ML, Roediger MP, Fieberg AM, Weintrob AC, Okulicz JF, Crum-Cianflone NF,

Ganesan A, Lalani T, Macalino GE, Chun HM.

Source

Infectious Disease Clinical Research Program, Uniformed Services University of

the Health Sciences, Bethesda, land; Infectious Disease Service, San

Military Medical Center, Fort Sam Houston, Texas. mlandrum@....

Abstract

Changes in serologic status in human immunodeficiency virus (HIV)/hepatitis B

virus (HBV) co-infected individuals with either isolated anti-HBc or resolved

HBV infection have been reported, but the frequency of clinically meaningful

long-term serologic changes is not well-defined. This study therefore, examined

longitudinal serologic status for hepatitis B surface antigen (HBsAg)-negative

HIV/HBV co-infected participants in a large cohort. Among 5,222 cohort

participants, 347 (7%) were initially isolated anti-HBc positive, and 1,073

(21%) had resolved HBV infection (concurrently reactive for anti-HBc and

anti-HBs). Thirty-three (10%) of the 347 participants with isolated anti-HBc

were later positive for HBsAg at least once, compared with 3 (0.3%) of those

with resolved HBV (P < 0.001). A total of 14 participants became

persistently positive for HBsAg and were thus classified as having late-onset

chronic HBV infection at a median of 3.7 years after initial HBV diagnosis. For

those initially with HBsAg-negative HIV/HBV co-infection, the rate of late-onset

chronic HBV infection was 1.39/1,000 person-years. Those with late-onset chronic

HBV infection experienced significant decreases in CD4 cell counts

(P = 0.002) with a mean of 132 cells/µl at the time of late-onset chronic

HBV infection, but no factor distinguished those who were positive for HBsAg

only once from those that developed late-onset chronic HBV infection. Over a

median of 2.9 years following late-onset chronic HBV infection, 3 of 14

subsequently lost HBsAg. The occurrence of late-onset chronic HBV infection in

HBsAg negative HIV/HBV co-infected adults appears to be one important, albeit

rare, clinical event seen almost exclusively in those with isolated anti-HBc and

low CD4 cell count. J. Med. Virol. 83:1537-1543, 2011. © 2011 Wiley-Liss, Inc.

Copyright © 2011 Wiley-Liss, Inc.

PMID: 21739443 [PubMed - in process]

[Guest guest]

http://www.ncbi.nlm.nih.gov/pubmed/21739443

J Med Virol. 2011 Sep;83(9):1537-43. doi: 10.1002/jmv.22155.

Development of chronic hepatitis B virus infection in hepatitis B surface

antigen negative HIV/HBV co-infected adults: A rare opportunistic illness.

Landrum ML, Roediger MP, Fieberg AM, Weintrob AC, Okulicz JF, Crum-Cianflone NF,

Ganesan A, Lalani T, Macalino GE, Chun HM.

Source

Infectious Disease Clinical Research Program, Uniformed Services University of

the Health Sciences, Bethesda, land; Infectious Disease Service, San

Military Medical Center, Fort Sam Houston, Texas. mlandrum@....

Abstract

Changes in serologic status in human immunodeficiency virus (HIV)/hepatitis B

virus (HBV) co-infected individuals with either isolated anti-HBc or resolved

HBV infection have been reported, but the frequency of clinically meaningful

long-term serologic changes is not well-defined. This study therefore, examined

longitudinal serologic status for hepatitis B surface antigen (HBsAg)-negative

HIV/HBV co-infected participants in a large cohort. Among 5,222 cohort

participants, 347 (7%) were initially isolated anti-HBc positive, and 1,073

(21%) had resolved HBV infection (concurrently reactive for anti-HBc and

anti-HBs). Thirty-three (10%) of the 347 participants with isolated anti-HBc

were later positive for HBsAg at least once, compared with 3 (0.3%) of those

with resolved HBV (P < 0.001). A total of 14 participants became

persistently positive for HBsAg and were thus classified as having late-onset

chronic HBV infection at a median of 3.7 years after initial HBV diagnosis. For

those initially with HBsAg-negative HIV/HBV co-infection, the rate of late-onset

chronic HBV infection was 1.39/1,000 person-years. Those with late-onset chronic

HBV infection experienced significant decreases in CD4 cell counts

(P = 0.002) with a mean of 132 cells/µl at the time of late-onset chronic

HBV infection, but no factor distinguished those who were positive for HBsAg

only once from those that developed late-onset chronic HBV infection. Over a

median of 2.9 years following late-onset chronic HBV infection, 3 of 14

subsequently lost HBsAg. The occurrence of late-onset chronic HBV infection in

HBsAg negative HIV/HBV co-infected adults appears to be one important, albeit

rare, clinical event seen almost exclusively in those with isolated anti-HBc and

low CD4 cell count. J. Med. Virol. 83:1537-1543, 2011. © 2011 Wiley-Liss, Inc.

Copyright © 2011 Wiley-Liss, Inc.

PMID: 21739443 [PubMed - in process]