Evolution of Hepatitis B Serological Markers in HIV-Infected Patients Receiving Highly Active Antiretroviral Therapy

Evolution of serological markers of hepatitis B virus (HBV) carriage or infection has rarely been investigated among human immunodeficiency virus (HIV)-infected patients receiving highly active antiretroviral therapy (HAART). During the period 1997-2002 a total of 633 HIV-infected patients were tested for HBV serological markers at baseline including hepatitis B surface antigen (HBsAg) antibody to HBsAg (anti-HBs ) antibody to hepatitis B core antigen (anti-HBc) hepatitis C virus (HCV) antibody (anti-HCV) antibody HCV RNA level and HBV DNA level all of which were retested at least 1 year apart. Medical records were reviewed to identify clinical characteristics associated with evolution of these serological markers. After a median duration of follow-up for 4.96 years 161 patients (25.4%) had changes in HBV serological markers. Of 119 patients (18.8%) who tested positive for HBsAg at baseline 6 (5.0%) developed anti-HBs and 9 (7.6%) developed isolated anti-HBc. Of 270 patients (42.7%) whotested positive for anti-HBs 18 (6.7%) lost anti-HBs. Of 179 patients (28.3%) in whom isolated anti-HBc had been detected 73 (40.8%) developed anti-HBs 18 (10.1%) lost all HBV markers and 7 (3.9%) developed HBsAg. Of 65 patients (10.2%) who tested negative for all HBV markers 13 (20%) developed anti-HBs 13 (20%) developed isolated anti-HBc and 4 (6.2%) developed HBsAg indicating a high risk of HBV exposure. Patients in whom anti-HBc was detected at baseline were more likely to have acquired immunodeficiency syndrome (P = .008). Multivariate analysis revealed that an increase in the CD4 cell count after the commencement of HAART was significantly associated with persistence or subsequent development of anti-HBs in patients with anti-HBs or anti-HBc at baseline respectively. Periodic measurements of HBV serological markers in HIV-infected patients are recommended because new HBV infections and changes of HBV serological markers are not uncommon in patients with improved immunity after commencement ofHAART. (authors)