Abstract
BackgroundThe prevalence of hepatitis B virus (HBV) infection and human immunodeficiency virus (HIV) infection in Mozambique is one of the highest in the world, though in spite of this the prevalence of occult hepatitis B infection (OBI) is unknown.ObjectivesThis study was conducted with the aim to investigate the prevalence of OBI and frequency of isolated hepatitis B core antibody (anti-HBc alone) among antiretroviral (ART) naïve HIV-positive patients in Mozambique.MethodsA cross-sectional study was conducted in two health facilities within Maputo city. All ART-naive HIV seropositive patients attending outpatient clinics between June and October 2012 were consecutively enrolled. Blood samples were drawn from each participant and used for serological measurement of HBV surface antigen (HBsAg), antibodies against HBV surface antigen (anti-HBs) and antibodies against core antigen (anti-HBc) using ELISA. Quantification of HBV DNA was performed by real time PCR. A questionnaire was used to obtain demographics and clinical data.ResultsOf the 518 ART-naive HIV-positive subjects enrolled in the study, 90.9% (471/518) were HBsAg negative. Among HBsAg negative, 45.2% (213/471) had isolated anti-HBc antibodies, and the frequency of OBI among patients with anti-HBc alone was 8.3% (17/206). OBI was not correlated either with CD4+ T cells count or transaminases levels. A total of 11.8% of patients with OBI presented elevated HBV DNA level. Frequency of individuals with APRI score > 2 and FIB-4 score > 3.25 was higher in patients with OBI as compared not exposed, immune and anti-HBc alone patients.ConclusionOur data demonstrate for the first time that OBI is prevalent among HIV patients in Mozambique, and will be missed using the commonly available serological assays that measures HBsAg.
Highlights
Occult hepatitis B virus (HBV) infection (OBI) is defined as persistence of HBV DNA in the liver in the absence of detectable HBV surface antigen (HBsAg) [1]
Our data demonstrate for the first time that occult hepatitis B infection (OBI) is prevalent among human immunodeficiency virus (HIV) patients in Mozambique, and will be missed using the commonly available serological assays that measures HBsAg
In this study we used the same cohort of HIV infected patients of our recently published manuscript on HIV/HBV co-infection [22] to further investigate occurrence of OBI, and we found a prevalence of OBI of 8.3% in anti-HBc alone HIV infected patients, which was similar to that reported in other studies, but higher and lower frequencies had been described elsewhere [25,26,27,28,29,30,31]
Summary
Occult hepatitis B virus (HBV) infection (OBI) is defined as persistence of HBV DNA in the liver (with or without HBV DNA in serum) in the absence of detectable HBV surface antigen (HBsAg) [1]. In these patients, serum HBV DNA level is usually very low, mostly below 104 IU/mL. The clinical implications of OBI are not fully understood, but include: i) risk of HBV transmission through blood transfusion, hemodialysis, organ and bone marrow transplantation, and perinatal route due to the hidden status of HBV infection; ii) hepatitis B virus reactivation (HBVr) after immunosuppression; iii) risk of progression to chronic liver disease (CLD); iiii) risk of development of hepatocellular carcinoma (HCC) [1]. The prevalence of hepatitis B virus (HBV) infection and human immunodeficiency virus (HIV) infection in Mozambique is one of the highest in the world, though in spite of this the prevalence of occult hepatitis B infection (OBI) is unknown
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