Paper # 695
Prevalence and Clinical Course of Occult HBV Infection in Serology Negative HIV Patients in Johannesburg, South Africa
Cynthia Firnhaber1, C Yu Chen1, D Evans1, M Maskew1, D Schulze1, A Reyneke1, A Di Bisceglie2, and A Kramvis1
1Univ of the Witwatersrand, Johannesburg, South Africa and 2St Louis Univ, MO, US
Background: Occult HBV infection has been reported
in HIV patients in Johannesburg, South Africa, but the clinical significance is
unclear. We present the prevalence of HBV DNA in HBV serology negative HIV
patients and the results of a 2 year retrospective evaluation of these patients
with and without HBV occult DNA.
Methods: Using standard serology tests, 222 of 502
patients tested for hepatitis B were negative for hepatitis B surface antibody,
core antibody and surface antigen. DNA was extracted using the QIAamp MinElute
Virus Spin kit. An in-house real-time PCR, using primers targeting the
conserved HBV S-region, was used to quantify HBV DNA. A restriction fragment
length polymorphism assay was used to genotype the HBV DNA isolates. The
clinical course was evaluated retrospectively among patients with and without
occult HBV DNA for 2 years. Baseline differences between the 2 groups were
tested for using non-parametric statistics. Differences in clinical responses
at various time intervals after initiation of ART were estimated using the
Student’s t test for continuous variables (ie, liver transminases) and Chi
square tests for proportions (ie, regimen switch), respectively.
Results: HBV DNA was detected in 5.4% (12/222) of
the serology negative patients. The mean HBV viral load was 5,391.0 IU/mL. All
were genotype A except for one genotype C. Clinical data was available for
10/12 of the occult HBV group. There were no statistical differences in
baseline characteristics between the HBV DNA-positive and –negative groups. The
median baseline CD4 count was 67 cells/mm3 (IQR 15 to 180) and
105 cells/mm3 (IQR 48 to 148) in the HBV DNA-positive and in
the HBV DNA-negative groups, respectively. Baseline liver transaminases were
not significantly different, but the baseline AST was 53 and 37 U/L in the HBV
DNA-positive and negative groups, respectively. When the clinical course was
compared between the 2 groups, there was no difference in response to ART,
adverse events, and regimen change.
Conclusions: The reports on the clinical course of
patients with occult HBV DNA has been conflicting. We found 5.4% of the HIV
patients who were HBV serology negative had low levels of HBV DNA. However,
there were no significant clinical differences between those with and without
occult HBV DNA. The numbers studied were small and follow up with a larger
cohort is needed.
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