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Occult hepatitis B demonstrated by anti-HBc and HBV DNA in HIV-positive patients
Arezoo Honarmand1, Morteza Pourahmad2, Kavous Solhjoo3
1Microbiology Department, Islamic Azad University of Jahrom, Jahrom, Iran.
Insights
Occult hepatitis B infection (OBI) is prevalent in Iranian human immunodeficiency virus (HIV) patients, with nearly half testing positive for HBV DNA despite negative HBsAg tests. This highlights the need for improved diagnostic methods for OBI in this population.
Area of Science:
- Hepatology
- Virology
- Infectious Diseases
- Public Health
Background:
- Occult hepatitis B infection (OBI) is defined as hepatitis B virus (HBV) DNA-positive but HBV surface antigen (HBsAg)-negative status.
- OBI can exacerbate liver damage in patients with co-existing liver diseases and may reactivate in human immunodeficiency virus (HIV)-infected individuals.
- Standard HBV screening in Iran relies on HBsAg testing, potentially missing OBI cases.
Purpose of the Study:
- To determine the prevalence of occult hepatitis B infection (OBI) among HIV-positive patients in Iran.
- To assess the diagnostic limitations of routine HBsAg testing in identifying HBV infection in HIV patients.
Main Methods:
- A cross-sectional study was conducted in 2012 on sera from known and accessible HIV patients in Jahrom and Fassa, Iran.
- Samples were tested for HBsAg and HBV core antibody (HBcAb).
- HBV DNA testing was performed on HBsAg-negative samples.
Main Results:
- Of 91 HIV patients, 7.7% were HBsAg-positive and 49.5% were HBcAb-positive.
- Among 84 HBsAg-negative patients, 46.4% were HBcAb-positive.
- A significant proportion (63%) of HBsAg-negative patients were positive for HBV DNA, indicating OBI.
Conclusions:
- The prevalence of HBV infection, including OBI, is substantial in HIV-positive individuals in Iran.
- Current diagnostic methods (ELISA HBsAg) are insufficient for detecting OBI in HIV patients.
- More sensitive diagnostic tools are recommended for accurate HBV screening in this vulnerable population.
Background:
In patients who are hepatitis B virus (HBV) DNA-positive, but HBV surface antigen (HBsAg) -negative, the infection is referred to as occult hepatitis B infection (OBI). Occult HBV infection is harmful when other liver diseases are present, and can aggravate liver damage in in patients with chronic liver diseases. In human immunodeficiency virus (HIV) infection the suppression of viral replication by the immune system might be inactivated, and classical HBV infection in OBI patients may occur. Health care professionals should be aware of OBI in HIV patients. The routine test for HBV infection in Iran is the enzyme-linked immunosorbent assay for the HBV surface antigen (ELISA HBsAg); therefore, the aim of this study was to evaluate the prevalence of OBI in Iranian HIV patients.
Methods:
This cross-sectional study was conducted in 2012 on sera from all the known and accessible HIV patients in Jahrom and Fassa, two cities in southern Iran. All samples were tested for the HBsAg, HBV core antibody (HBcAb). All the results were analyzed using SPSS.
Results:
Of the 91 patients, seven (7.7%) were HBsAg-positive and forty-five (49.5%) were HBcAb-positive. In patients with negative HBsAg (84 patients), 39 (46.4%) were HBcAb positive and 53 (63%) were positive for HBV DNA.
Conclusion:
The prevalence of HBV infection is relatively high in HIV patients, and more accurate tests than those presently in use should be used for diagnosis.
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