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

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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 (Δ1) 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.

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Acknowledgments

This study was supported by grants from the San Raffaele, Scientific Institute and from the Istituto Superiore di Sanità (progetto AIDS N30S12, N 40S27).

Conflict of interest

For Sabrina Bagaglio (S.B.), Giampaolo Bianchi (G.B.), Anna Danise (A.D.), Caterina Uberti-Foppa ©. U-B.) Lucy Porrino (L.P.), Giulia Morsica (G.M.), there are not potential conflicts of interest. For Antonella Castagna (A.C.) and Adriano Lazzarin (A.L.) there are potential conflicts of interest as follows: A.C. has received grants, travel grants, and consultancy fees from Abbott, Boehringer-Inghelheim, BMS, Gilead Sciences, GSK, MSD, Pfizer, Roche, and Tibotec (Johnson & Johnson). A.L. has acted as a consultant, participated in an advisory board as a speaker or in the conduct of clinical trials for Abbott, BMS, Gilead, Tibotec, MSD, Roche, GSK, and BI.

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Authors and Affiliations

  1. Department of Infectious Diseases, San Raffaele Scientific Institute, via Stamira d’Ancona, 20, 20127, Milan, Italy

    S. Bagaglio, A. Danise, L. Porrino, C. Uberti-Foppa, A. Lazzarin, A. Castagna & G. Morsica

  2. Department of Internal Medicine, Aging and Nephrological Diseases, University of Bologna, Bologna, Italy

    G. Bianchi

  3. San Raffaele Scientific Institute, University Vita Salute, Milan, Italy

    A. Lazzarin

Authors
  1. S. Bagaglio
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  2. G. Bianchi
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  3. A. Danise
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  4. L. Porrino
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  5. C. Uberti-Foppa
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  6. A. Lazzarin
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  7. A. Castagna
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  8. G. Morsica
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Corresponding author

Correspondence to G. Morsica.

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Bagaglio, S., Bianchi, G., Danise, A. et al. Longitudinal evaluation of occult Hepatitis B infection in HIV-1 infected individuals during highly active antiretroviral treatment interruption and after HAART resumption. Infection 39, 121–126 (2011). https://doi.org/10.1007/s15010-011-0093-9

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  • DOI: https://doi.org/10.1007/s15010-011-0093-9

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