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Occult hepatitis B virus (HBV) and hepatitis C virus (HCV) viremia in women with and at-risk for HIV/AIDS
Presented by Lynn Taylor, United States.
L. Taylor1, P. Gholam2, A. Delong1, A. Rompalo3, R. Klein4, P. Schuman5, L. Gardner6, C. Carpenter1, HIV Epidemiology Research (HER) Study Group
1Brown University, Providence, United States, 2Case Western Reserve University, Cleveland, United States, 3Johns Hopkins University School of Medicine, Baltimore, United States, 4Albert Einstein College of Medicine, New York, United States, 5Virginia Commonwealth University, Richmond, United States, 6Centers for Disease Control & Prevention, Atlanta, United States
Background: Occult HBV infection (OHBV, persistent HBV DNA in plasma without detectable HBV surface antigen [HBsAg]), and occult HCV infection (OHCV, persistent HCV RNA without detectable HCV antibody [HCVAb]) may be under-recognized in women with or at-risk for HIV/AIDS.
Methods: We explored the frequency and determinants of OHBV and OHCV in 845 HIV-positive and HIV-negative women participants of the HER Study, matched by age, race and HIV risk factors. OHBV/OHCV was defined as persistent HBV/HCV viremia without HBsAg or HCVAb respectively at two timepoints >= six months apart, to differentiate these conditions from acute HBV or HCV infection prior to development of HBsAg or HCVAb, and from HBV during viral clearance with HBsAg loss. Interviews and plasma were obtained semiannually from 1993-1999. Baseline serologies included HBV core antibody (HBcAb), HBsAg for HBcAb-positives, and HCVAb. Baseline HBcAb-negatives were considered HBsAg-negative. Using ultrasensitive nucleic acid assays (COBAS® TaqMan PCR, cutoff <15 IU/ml), we assessed HBV/HCV viremia in 549 HIV-infected and 296 HIV-uninfected participants with available repository samples. We determined prevalence of occult infections and associations between occult infections, CD4+ and HIV RNA.
Results: Of 823 HBsAg-negatives, 26 (3.2%) had OHBV; all were HIV-infected. Compared to HIV-positives with chronic HBV (HBsAg-positive, DNA-positive), OHBV was associated with HCV RNA-positivity (77% versus 27%; Odds Ratio [OR] 8.3, 95% confidence interval [CI] 1.4-64.7, p=0.008) and IDU history (88% versus 45%; OR 8.5, CI 1.3-72.1, p=0.011). Compared to HIV-infected/HBV-exposed (any serological evidence of HBV exposure in the absence of DNA or vaccination), OHBVs had higher median HIV RNA (36,725 vs. 4,480 copies/mL, p<0.001) and lower median CD4+ (205 vs. 326 cells/mm3, p=0.03). Of 381 HCVAb-negatives, one (HIV-seropositive) had OHCV.
Conclusions: OHBV is associated with HIV infection; OHBV was present in >3% of HIV-infected women and may be a larger problem for women with poor control of HIV. OHCV occurred rarely.
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