Journal Article

Evolution of Hepatitis B Serological Markers in HIV-Infected Patients Receiving Highly Active Antiretroviral Therapy

Wang-Huei Sheng, Jia-Horng Kao, Pei-Jer Chen, Li-Ming Huang, Sui-Yuan Chang, Hsin-Yun Sun, Chien-Ching Hung, Mao-Yuan Chen and Shan-Chwen Chang

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 45, issue 9, pages 1221-1229
Published in print November 2007 | ISSN: 1058-4838
Published online November 2007 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/522173
Evolution of Hepatitis B Serological Markers in HIV-Infected Patients Receiving Highly Active Antiretroviral Therapy

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Background. Evolution of serological markers of hepatitis B virus (HBV) carriage or infection has rarely been investigated among human immunodeficiency virus (HIV)-infected patients receiving highly active antiretroviral therapy (HAART).

Methods. During the period 1997–2002, a total of 633 HIV-infected patients were tested for HBV serological markers at baseline, including hepatitis B surface antigen (HBsAg), antibody to HBsAg (anti-HBs ), antibody to hepatitis B core antigen (anti-HBc), hepatitis C virus (HCV) antibody (anti-HCV) antibody, HCV RNA level, and HBV DNA level, all of which were retested at least 1 year apart. Medical records were reviewed to identify clinical characteristics associated with evolution of these serological markers.

Results. After a median duration of follow-up for 4.96 years, 161 patients (25.4%) had changes in HBV serological markers. Of 119 patients (18.8%) who tested positive for HBsAg at baseline, 6 (5.0%) developed anti-HBs, and 9 (7.6%) developed isolated anti-HBc. Of 270 patients (42.7%) who tested positive for anti-HBs, 18 (6.7%) lost anti-HBs. Of 179 patients (28.3%) in whom isolated anti-HBc had been detected, 73 (40.8%) developed anti-HBs, 18 (10.1%) lost all HBV markers, and 7 (3.9%) developed HBsAg. Of 65 patients (10.2%) who tested negative for all HBV markers, 13 (20%) developed anti-HBs, 13 (20%) developed isolated anti-HBc, and 4 (6.2%) developed HBsAg, indicating a high risk of HBV exposure. Patients in whom anti-HBc was detected at baseline were more likely to have acquired immunodeficiency syndrome (P = .008). Multivariate analysis revealed that an increase in the CD4 cell count after the commencement of HAART was significantly associated with persistence or subsequent development of anti-HBs in patients with anti-HBs or anti-HBc at baseline, respectively.

Conclusions. Periodic measurements of HBV serological markers in HIV-infected patients are recommended, because new HBV infections and changes of HBV serological markers are not uncommon in patients with improved immunity after commencement of HAART.

Journal Article.  4650 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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