Incidence of transaminitis among HIV-infected patients with occult hepatitis B

Lo Re, Vincent; Wertheimer, Benjamin; Localio, A. Russell; Kostman, Jay R.; Dockter, Janel; Linnen, Jeffrey M.; Giachetti, Cristina; Dorey-Stein, Zachariah; Frank, Ian; Strom, Brian L.; Gross, Robert

doi:10.1016/j.jcv.2008.03.030

« Previous Next »Journal of Clinical Virology
Volume 43, Issue 1 , Pages 32-36, September 2008

Incidence of transaminitis among HIV-infected patients with occult hepatitis B☆

Vincent Lo Re III
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
- Center for Education and Research on Therapeutics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
- Corresponding author at: Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, 711 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021, USA. Tel.: +1 215 573 5964; fax: +1 215 349 5111.
Benjamin Wertheimer
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
A. Russell Localio
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
- Center for Education and Research on Therapeutics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
Jay R. Kostman
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
Janel Dockter
- Gen-Probe Incorporated, San Diego, CA, USA
Jeffrey M. Linnen
- Gen-Probe Incorporated, San Diego, CA, USA
Cristina Giachetti
- Gen-Probe Incorporated, San Diego, CA, USA
Zachariah Dorey-Stein
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
Ian Frank
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
Brian L. Strom
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
- Center for Education and Research on Therapeutics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
Robert Gross
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
- Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
- Center for Education and Research on Therapeutics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA

Received 28 August 2007; received in revised form 21 March 2008; accepted 28 March 2008. published online 20 May 2008.

Abstract

Background

The clinical significance of occult hepatitis B virus (HBV) infection, defined as the presence of HBV DNA in individuals with HBV core antibodies (anti-HBc) in the absence of HBV surface antigen (HBsAg), is unclear in HIV-infected patients. This information is needed to determine the importance of detecting and treating occult HBV in this population.

Objective

To determine if HIV-infected patients with occult HBV infection have an increased incidence of transaminitis.

Study design

We performed a cohort study among randomly selected HBsAg−/anti-HBc+ HIV-infected patients in the Penn CFAR Database and Specimen Repository. HBV DNA was qualitatively detected using a transcription-mediated amplification assay. Hepatic transaminase levels, the main study outcome, were collected at 6-month intervals from the time of occult HBV determination.

Results

Among 97 randomly selected subjects without baseline transaminitis, 13 (13%) had occult HBV. These subjects more frequently had detectable HIV RNA. The 2-year incidence of transaminitis among HIV-infected subjects with occult HBV (50 events/100 person-years) was not significantly different from those without occult HBV (38 events/100 person-years; adjusted incidence rate ratio=1.36 [95% CI, 0.72–2.59]).

Conclusions

Occult HBV did not increase the incidence of hepatic transaminitis over 2 years. Future studies should determine whether occult HBV is associated with other clinically important outcomes, particularly hepatocellular carcinoma.

Keywords: Occult hepatitis B virus, HIV/hepatitis B virus coinfection, HIV, Transaminitis