FREQUENT CHRONIC HEPATITIS-B VIRUS-INFECTION IN HIV-INFECTED PATIENTSPOSITIVE FOR ANTIBODY TO HEPATITIS-B CORE ANTIGEN ONLY

Persons with immune deficiency may present with atypical results in se rological tests for hepatitis B virus (HBV). Frozen serum specimens th at were sequentially obtained over time from a cohort of 57 HIV-infect ed patients, all of whom tested positive only for antibody to hepatiti s B core antigen (anti-HBcAg), were therefore retested for HBV markers , including HBV DNA. The results were assessed for their time course a nd correlated with clinical data and alanine aminotransferase (ALT) va lues. Forty-eight patients were male; intravenous drug users constitut ed the principal risk group (n = 30), followed by homosexual men (n = 22). Thirty-three persons tested positive for antibody to hepatitis C virus (anti-HCV). During a median of 31 months from the first to the l ast serum, anti-HBcAg remained the sole marker of HBV infection in 98. 2% of the patients. Polymerase chain reaction (PCR) to detect DNA for HBV core and HBV surface gene was positive in 126 (62.4%) and 121 (59. 9%) of all 202 serum samples, respectively. Over time, HBV DNA was det ected at least once in 51 (89.5%) patients. In contrast, de-complexed hepatitis B surface antigen (HBsAg) was detected at least once in 14 ( 24.6%) patients. Among patients positive for HBV DNA and negative for anti-HCV, eight (36.4%) of 22 had chronic hepatitis (ALT elevation gre ater than or equal to 6 months) that was attributable only to persisti ng HBV infection. Similarly, 12 (41.4%) of 29 patients positive for bo th HBV DNA and anti-HCV had chronic viral hepatitis, but their ALT val ues were significantly higher. In HIV-infected patients, anti-HBcAg as the sole serological HBV marker detected must be considered indicativ e of chronic HBV infection and is in part associated with chronic hepa titis and ALT elevation.