HEPATITIS-B SEROLOGY AND DNA DETECTION IN MULTITRANSFUSED HEMOPHILIACS AND FACTOR-VIII AND FACTOR-IX CONCENTRATES

To assess the effect of HIV infection and the introduction of virus-in activated concentrates, we conducted a retrospective 20-year longitudi nal study of hepatitis B virus (HBV) serology and look for HBV DNA in recent serum samples of 63 multiply transfused haemophiliacs. Of 63 ha emophiliacs, 51 had evidence of previous HBV infection and 12 vaccinee s had anti-HBs only. Of 40 HIV-negative, two had persistent HBsAg but all were HBV DNA negative. All 23 HIV-positive were HBsAg-negative. Lo ss of anti-HBc(46% vs. 17.5%) and anti-HBs (32% vs. 14%) was more comm only seen in HIV-infected compared with noninfected individuals. One H IV-positive individual had HBV DNA detectable by PCR. Restrospective t esting demonstrated that re-emergence was associated with loss of anti -HBs and advanced HIV infection (CD4<50x10(6-1)L CDC II), although eig ht other with CDC IV disease were HBV DNA negative. Forty-three batche s of concentrates produced between 1965 and 1992 from both commercial and volunteer donors and subjected to different donor screening and vi rus inactivation methods were negative for HBV DNA. Some of these may have been infectious for HBV and therefore being negative for HBV may not equate with noninfectivity. We conclude that both HIV-positive and -negative haemophiliacs have lost protective antibodies against HBV s ince 1984 and that virus replication may re-emerge at least in the HIV -positive group. These observations may have implications for the mana gement of their chronic liver disease and the risk of infection of sex ual partners and medical attendants.