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1 November 2007

Volume 45, Number 9
Clinical Infectious Diseases 2007;45:1221–1229
© 2007 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2007/4509-0017$15.00
DOI: 10.1086/522173
HIV/AIDS MAJOR ARTICLE

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

Wang‐Huei Sheng,1,3,6,a

Jia‐Horng Kao,5,a

Pei‐Jer Chen,5

Li‐Ming Huang,2

Sui‐Yuan Chang,4

Hsin‐Yun Sun,1,3

Chien‐Ching Hung,1,3

Mao‐Yuan Chen,1,3 and

Shan‐Chwen Chang1,3

Departments of 1Internal Medicine and 2Pediatrics, National Taiwan University Hospital, Departments of 3Internal Medicine and 4Clinical Laboratory Sciences and Medical Biotechnology and 5Graduate Institutes of Clinical Medicine, National Taiwan University College of Medicine, and 6Department of Internal Medicine, Far‐East Memorial Hospital, Taipei, Taiwan

Background.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).

Methods.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.

Results.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%) who tested 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 ( ). 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.

Conclusions.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 of HAART.

Received 20 March 2007; accepted 13 July 2007; electronically published 21 September 2007.

Reprints or correspondence: Dr. Chien‐Ching Hung, Dept. of Internal Medicine, National Taiwan University Hospital, 7 Chung‐Shan South Rd., Taipei, Taiwan ().

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  • Presented in part: 14th Conference on Retroviruses and Opportunistic Infections, Los Angeles, California 25–28 February 2007 (abstract 941).

  • W.‐H.S. and J.H.K. contributed equally to this article.

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