Occult hepatitis B virus infection in ART-naive HIV-infected patients seen at a tertiary care centre in north India.
Occult hepatitis B virus infection in ART-naive HIV-infected patients seen at a tertiary care centre in north India.
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DOI：
10.1186/1471-2334-10-53
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发表时间：
2010-03-07
影响因子：
3.7
通讯作者：
Singh S
中科院分区：
文献类型：
--
作者：
Gupta S;Singh S
由于共同的传播途径，B和C型肝炎病毒与艾滋病毒的合并感染很常见。在大多数三级医疗卫生机构，艾滋病毒反应患者进行常规检测HBsAg和抗HCV抗体，以排除这些合并感染。然而，使用常规的血清学标志物只能检测活动性HBV感染，而隐匿性HBV感染可能会被遗漏。印度关于HIV-HBV合并感染的数据不足，甚至缺乏关于这一群体中隐匿性HBV感染的数据。我们估计了印度北部一家三级医疗中心HIV检测阳性患者的HBV感染负担。我们还试图确定这些未经治疗的患者中隐匿性HBV感染的患病率和临床特征，并将其人口统计学特征与其他HIV患者进行比较。从2002年1月至2007年12月，对837例HIV阳性患者（男631例，女206例，男女比例为3.06：1）进行了HBV（HBsAg）和HCV（抗-HCV抗体）血清学标志物检测。为了比较，1000名明显健康的HIV阴性器官捐献者也被纳入研究。记录这些患者的人口统计学、性行为、病史、实验室检查（包括血清ALT和CD 4计数）数据。采用高灵敏度的定性PCR方法对53例HBsAg阴性的HIV阳性患者的抗-HBs、抗-HBc总（IgG+IgM）和HBV-DNA进行了检测，并进行了回顾性分析。总体而言，7.28%的HIV阳性患者显示存在HBsAg，而HIV阴性对照组为1.4%。男性HBsAg阳性率（8.55%）高于女性（3.39%）。研究表明，24.5%的抗HBc抗体阳性患者中普遍存在可检测到HBV-DNA的隐性HBV感染;在HBsAg阴性患者中，这一比例为45.5%。最重要的是，20.7%的抗-HBs阳性患者存在隐匿性感染。但在血清阴性患者中均未检出HBV-DNA。9例HBV-DNA阳性患者中5例（55.6%）丙氨酸转氨酶升高，66.7%的患者CD 4 + T细胞计数低于200个/cumm。在我们的患者中发现HIV-HBV合并感染的高患病率。如果仅使用常规血清学标记物，相当数量的合并感染患者仍未得到诊断。抗-HBs抗体的存在不是排除隐匿性HBV感染的可靠替代标志物。诊断HIV血清学阳性患者中隐匿性HBV合并感染的最可靠方法是HBV-DNA检测。
Co-infections of hepatitis B and C viruses are frequent with HIV due to shared routes of transmission. In most of the tertiary care health settings, HIV reactive patients are routinely tested for HBsAg and anti-HCV antibodies to rule out these co-infections. However, using the routine serological markers one can only detect active HBV infection while the occult HBV infection may be missed. There is insufficient data from India on HIV-HBV co-infection and even scarce on occult HBV infection in this group. We estimated the burden of HBV infection in patients who were tested positive for HIV at a tertiary care centre in north India. We also attempted to determine the prevalence and clinical characteristics of occult HBV infection among these treatment-naïve patients and compare their demographic features with other HIV patients. During a period of 6 years between January 2002 to December 2007, 837 HIV positive patients (631 males and 206 females (M: F :: 3.06:1) were tested for serological markers of HBV (HBsAg) and HCV (anti-HCV antibodies) infections in our laboratory. For comparison 1000 apparently healthy, HIV-negative organ donors were also included in the study. Data on demographics, sexual behaviour, medical history, laboratory tests including the serum ALT and CD4 count of these patients were recorded. A sub-group of 53 HBsAg negative samples from HIV positive patients were assessed for anti-HBs, anti-HBc total (IgG+IgM) and HBV-DNA using a highly sensitive qualitative PCR and analysed retrospectively. Overall, 7.28% of HIV positive patients showed presence of HBsAg as compared to 1.4% in the HIV negative control group. The prevalence of HBsAg was higher (8.55%) in males than females (3.39%). The study revealed that occult HBV infection with detectable HBV-DNA was prevalent in 24.5% of patients positive for anti-HBc antibodies; being 45.5% in HBsAg negative patients. Most importantly the occult infection was seen in 20.7% patients who were positive for anti-HBs antibodies. However, in none of the seronegative patient HBV-DNA was detected. Five of the nine HBV-DNA positive (55.6%) patients showed raised alanine aminotransferase levels and 66.7% had CD4+ T cell counts below 200 cells/cumm. High prevalence of HIV-HBV co-infection was found in our patients. A sizeable number of co-infected patients remain undiagnosed, if only conventional serological markers are used. Presence of anti-HBs antibodies was not a reliable surrogate marker to rule out occult HBV infection. The most reliable method to diagnose occult HBV co-infection in HIV seropositive patients is the detection of HBV-DNA.
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影响因子：
25.7
作者：
Saraswat, S;Banerjee, K;Naik, S
通讯作者：
Naik, S
影响因子：
3.8
作者：
Haverkamp, M;Smit, M;Hoepelman, AIM
通讯作者：
Hoepelman, AIM
影响因子：
13.5
作者：
Colin, JF;Cazals-Hatem, D;Marcellin, P
通讯作者：
Marcellin, P
影响因子：
25.7
作者：
GRUMAYER, ER;PANZER, S;GADNER, H
通讯作者：
GADNER, H
影响因子：
3.8
作者：
WAITE, J;GILSON, RJC;TEDDER, RS
通讯作者：
TEDDER, RS