Incidence of transaminitis among HIV-infected patients with occult hepatitis B☆
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.
aDivision of Infectious Diseases, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
bDepartment of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
cCenter for Education and Research on Therapeutics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
dDepartment of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, 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.
☆ These results were presented, in part, at the 14th Conference on Retroviruses and Opportunistic Infections in Los Angeles, CA [Abstract 929].
ABSTRACT