Research Article
ISSN: 2572-102X

Serological profiles of HBV among HIV-infected patients in Istanbul, Turkey

Hayat Kumbasar Karaosmanoğlu*1, Bilgül Mete2, Alper Gunduz3, Ozlem Altuntas Aydin1, Fatma Sargin4, Dilek Yildiz Sevgi3, Bulent Durdu5, İlyas Dokmetas3, Fehmi Tabak2
1Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Turkey
2Istanbul University Cerrahpasa Medical Faculty, Turkey
3Sisli Etfal Hamidiye Training and Research Hospital, Turkey
4Medeniyet University Medical Faculty, Turkey
5Bezmi Alem University Medical Faculty, Turkey
Corresponding author: Hayat Kumbasar Karaosmanoğlu
Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey. Tel: +90 506 453 92 40, Email: drhayat1@hotmail.com
Received Date: July 05, 2018 Accepted Date: July 15, 2018 Published Date: August 01, 2018
Citation:Hayat Kumbasar Karaosmanoğlu et al. (2018), Serological profiles of HBV among HIV-infected patients in Istanbul, Turkey Int J clinical & case. 2:5, 44-47.
Copyright: ©2018 Hayat Kumbasar Karaosmanoğlu et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited


We aimed to determine the serological profiles of HBV among HIV-infected patients in Istanbul A multicentre retrospective study has been conducted by ACTHIV-IST study group. Demographic and laboratory data were collected from the patients’ files. A total of 567 HIV/AIDS patients were included in this study. Mean age was 38.5 years ± 11.2 and 81.5% were male. Serological profiles: 8.4% had current HBV infection, 9.3% had been vaccinated and 16.8 % had past infection. Parameters associated with current infection were lower CD4 counts (p <0.05). Of 58 patients with isolated anti-HBc , 29 were tested for serum HBV DNA and 3 of them were positive. Serological profiles of HBV must be assesed among HIV-infected patients and vaccination must be offered.

Keywords:  Public Health Facilities, Childhood Morbidity, Child Health, Respiratory Infections, Statistical Models




Introduction


Worldwide, human immunudeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) are major public health problems. Liver disease is currently the major concern in HIV-infected patients coinfected with hepatitis B virus (HBV) or hepatitis C virus (HCV)[1,2]. HBV-HIV or HCV-HIV patients have more rapid progression of liver disease than those with HBV or HCV mono-infection. End-stage liver disease, such as liver cirrhosis or hepatocellular carcinoma, is commonly observed in patients with HBV-HIV or HCV-HIV coinfection[3-6]. Thus, national guidelines recommend that all HIV-infected patients should be tested for hepatitis viruses.

Due to common transmission routes, HBV and HCV infections are frequently seen together with HIV/AIDS [7]. The prevalences of coinfection with HBV and HCV in HIV-infected patients have been variable, depending on the geographic regions and risk groups[8,9]. There is unsufficient data from Turkey on HIV/HBV coinfections. We aimed to determine the serological profiles of HBV among HIV-infected patients in Istanbul, Turkey which is classified as an intermediate HBV, low HIV endemic region.

Methodology


A multicentre observational retrospective study has been conducted by ACTHIV-IST study group, including 4 centres following-up HIV patients in Istanbul. Patients followed-up between January 2006-November 2012 were enrolled in this study.

Three of these centers are located in university hospitals and two are in public training hospitals. All newly diagnosed HIV/AIDS patients with confirmed diagnosis through Western Blot verification test (HIV BLOT 2.2, MP Biomedicals Asia Pacific, Singapore) who attended the abovementioned clinics between January 2006 and November 2013 were includedThe patients were screened for HBsAg, anti-HBc IgG, anti-HBS and anti-HCV by ELISA method (Inno-test HCV Ab IV, Innogenetics, Belgium) and HBV DNA levels of seropositive patients were detected by polymerase chain reaction (PCR) (COBAS Ampliprep/COBAS TaqMan 96, Roche Molecular Systems, USA). The CD4+ cell counts were obtained by standard flow cytometry (FACScalibur, Becton Dickinson, New Jersey, USA) and HIV viral load was measured by PCR (COBAS Ampliprep/COBAS TaqMan HIV-1 Test, Roche Molecular Systems, USA). Demographic data including age, sex, transmission routes, and history of imprisonment, CD4+ counts, HIV RNA, HBsAg, anti-HBc IgG, anti-HBS and anti-HCV, HBV DNA, HCV RNA were collected retrospectively from medical records and were transferred to a HIV database system. Serological profiles of HBV were classified into four groups; current HBV infection, isolated anti-HBc, past infection and vaccinated.

All analysis were performed by using GraphPad Prism 5.0 (GraphPad Software, Inc., San Diego, CA, USA) and SPSS 15 (SPSS Inc, Chicago, IL, USA). Data were described using mean ± standard deviation (SD) (or median and range) and as an absolute number and percentage when indicated. The student t test was used to analyze quantitative data. A P value < 0.05 was considered as statistically significant.

Results


A total of 567 HIV/AIDS patients were included in this study. Mean age was 38.5 years ± 11.2 (range: 18-79) and 81.5% were male. Four hundred twenty nine patients were tested for all HBV markers such as HBsAg, anti-HBc IgG, and anti-HBs. Serological profiles of these patients were shown in table 1: 8.4% had current HBV infection, 9.3% had been vaccinated and 16.8 % had past infection. Of 58 (13.5%) patients with isolated anti-HBc , 29 were tested for serum HBV DNA and 3 of them were positive. The relationship between serological profiles of HBV and patient baseline characteristics were shown in table 2.

ijcc Digital images
Table 1:Serological profiles of HBV infection in patients infected with HIV

ijcc Digital images
Table 2: The relationship between serological profiles of HBV and patient baseline characteristics

Discussion


Worldwide, about 90% of HIV-infected patients have biologycal signs of prior HBV infection, and 5%-15% suffer from chronic infection 1) Turkey is classified as an intermediate HBV, low HIV endemic region. The estimated overall HBV infection prevalence is 4.57 [10]. Although, many studies have been published about the prevalances of HBV infection among different populations in Turkey, there is insufficient data in HIV-infected patients. In this first study, we investigated the prevalence and epidemiological features of HBV coinfection in HIV-infected Turkish individuals. A total of HIV-infected patients, 8.4 % had chronic hepatitis B and 16.8% had resolved HBV infection. In our study, current HBV infection in HIV-infected patients is more common than in the general population . This may be caused by similarities in routes of transmission and risk factors between HBV and HIV.

We observed a significant association between having a lower CD4 cell count and current HBV infection. This result supports the fact that most immunocompromised patients are unable to control their HBV infection [11], and/or these patients may experience HBV reactivation [12]. The alternative explanation to our observation could be that HBV co-infections may have cause further damage to the patients’ immune system which can subsequently boost HIV replication and lower CD4 counts.

Isolated anti-HBc is another common serologic pattern in HIV-infected patients. In published studies from different regions, the prevalance of isolated anti-HBc in HIV-infected populations ranged from 10.6-45 % [13,19]. The significiance of this serological pattern is unclear. It may represent either 1) resolved HBV infection with loss of anti-HBs, 2) a false positive test result, or 3) occult chronic HBV infection [20].

In our country, the prevaleance of isolated anti-HBc in general population ranges between 3%-5% in the previous studies [21,22]. In this study, isolated anti-HBc was determined in 58 (13.5 %) HIV-infected patients and this serologic profile was significantly more frequent thangeneral population. The prevaleance of occult infection in HIV-infected patients with isolated anti-HBc ranged from 0% to 89.5% [13,14,17,23,24]. In our study, of patients with isolated anti-HBc , 29 were tested for serum HBV DNA and 3 (10.3%) of them had occult infection. The difference of prevalance may be related with the regions, risk factors, use of ART and the sensitivity of the biology tecniques.

Conclusion

Current HBV infection and isolated anti-HBc prevalences are high among our HIV-infected patients. Parameters associated with current HBV infection were lower CD4 counts and increased ALT levels. Occult HBV infection was identified in 10.3% of patients with isolated anti-HBc tested for HBV DNA. Serological profiles of HBV must be assesed among HIV-infected patients and HBV vaccination must be offered in those without HBV markers. Determination of HBV DNA should be performed in patients with isolated anti-HBc to rule out the presence of occult infection.


References:

  1. Alter MJ (2006) Epidemiology of viral hepatitis and HIV co-infection. J Hepatol Suppl 44:6–9.
  2. Bica I, McGovern B, Dhar R, Stone D, McGowan K, Scheib R, Snydman DR (2001) Increasing mortality due to end-stage liver disease in patients with human immunodeficiency virus infection. Clin Infect Dis 32:492–497.
  3. Hoffmann CJ, Thio CL (2007) Clinical implications of HIV and hepatitis B co-infection in Asia and Africa. Lancet Infect Dis 7:402–409.
  4. Nikolopoulos GK, Paraskevis D, Hatzitheodorou E, Moschidis Z, Sypsa V, Zavitsanos X, Kalapothaki V, Hatzakis A (2009) Impact of hepatitis B virus infection on the progression of AIDS and mortality in HIV-infected individuals: a cohort study and meta-analysis. Clin Infect Dis 48:1763–1771.
  5. Sánchez-Quijano A, Andreu J, Gavilán F, Luque F, Abad MA, Soto B, Muñoz J, Aznar JM, Leal M, Lissen E (1995) Influence of human immunodeficiency virus type 1 infection on the natural course of chronic parenterally acquired hepatitis C. Eur J Clin Microbiol Infect Dis 14:949–953.
  6. Soto B, Sánchez-Quijano A, Rodrigo L, del Olmo JA, García-Bengoechea M, Hernández-Quero J, Rey C, Abad MA, Rodríguez M, Sales Gilabert M, González F, Mirón P, Caruz A, Relimpio F, Torronteras R, Leal M, Lissen E (1997) Human immunodeficiency virus infection modifies the natural history of chronic parenterally-acquired hepatitis C with an unusually rapid progression to cirrhosis. J Hepatol 26:1–5.
  7. Centers for Disease Control and Prevention (2001) Updated US Public Health Service guidelines for the management of occupational exposures to HBV, HCV, and HIV and recommendations for postexposure prophylaxis. MMWR Rec Rep 50:1-42.
  8. Jindal N, Arora U, Singh K (2008) Prevalence of Human Immunodeficiency Virus, HBV, HCV in Three Groups of Populations at High Risk of HIV Infection in Amristar, Northern India. Jpn J Infect Dis 61:79–81.
  9. Rockstroh JK (2003) Management of hepatitis B and C in HIV coinfected patients. J Acquir Immune Defi c Syndr 34:59–65.
  10. Toy M, Onder FO, Wormann T, Bozdayi AM, Schalm SW (2011) Age- and region-specific hepatitis B prevalence in Turkey estimated using generalized linear mixed models: a systematic review. BMC Infectious Diseases 11:337
  11. Noubiap JJ, Aka PV, Nanfack AJ, Agyingi LA, Ngai JN, Nyambi PN (2015) Hepatitis B and C Co-Infections in Some HIV-Positive Populations in Cameroon, West Central Africa: Analysis of Samples Collected Over More Than a Decade. PLoS One 10: e0137375.
  12. Honge BL, Jespersen S, Medina C, Wejse C, Erikstrup C (2016) Comment on Lo et al.: Prevalence of hepatitis B markers in Senegalese HIV-1 infected patients. J Med Virol 88: 1653–1654.
  13. Santos EA, Yoshida CF, Rolla VC, Mendes VC, Vieira IF, Arabe J, Gomes SA (2003) Frequent occult hepatitis B virus infection in patients infected with human immunodeficiency virus type 1 22:92-98
  14. Piroth L, Binquet C, Vergne M, Minello A, Livry C, Bour JB, Buisson M, Duong M, Grappin M, Portier H, Chavanet P (2002) The evolution of hepatitis of hepatitis B virus serological patterrns and the clinical relevance of isolated antibodies to hepatitis B core antigen in HIV infected patients. J Hepatol 36:681-686
  15. Osborn MK, Guest JL, Rimland D (2007) Hepatitis B and HIV coinfectio: Relation of different seological patterns to survival and liver disease. HIV Med 8:271-279
  16. French AL, Operskkalski E, Peters M, Strickler HD, Tien PC, Sharp GB, Glesby MJ, Young M, Augenbraun M, Seaberg E, Kovacs A (2007) Isolated hepatitis B core antibody is associated with HIV and ongoing but not resolved hepatitis C virus infection in a cohort of US women. J Infect Dis 195:1437-1442
  17. Perez-Rodriguez MT, Sopena B, Crespo M, Rivera A, Gonzalez del Blanco T, Ocampo A, Martinez-Vazquez (2009) Clinical Significance of '' anti-HBc alone'' in human immunodeficiency virus-positive patients. World J Gastroenterol 15:1237-1242
  18. Firnhaber C, Viana R, Reyneke A, Schultze D, Malope B, Maskew M, Bisceglie AD, MacPhail P, Sanne L, Kew M (2009) Occult hepatitis B vius infections in patients with isolated core antibody and HIV co-infection in an urban clinic in Johannesbug, South Africa. Int 13:488-492
  19. Remazani A, Banifazi M, Eslamifar A, Aghakhani A (2010) Seological pattern of anti-HBc alone infers occult hepatitis B virus infection in high-risk individuals in Iran. J Infect Dev Ctries 4:658-661
  20. Brechot C, Thiers V, Kremsdorf D, Nalpas B, Pol S, Paterlini-Brechot P (2001) Persistent hepatitis B virus infection in subjects without hepatitis B surface antigen: clinically significant or purely "occult"? Hepatology 34:194-203.
  21. Altunay H, Kenar S, Kocak N, Cavuslu S (2003) Investigation of hepatitis B viral infectiosity associated with isolated anti-HBc positivity. Viral Hepatit Derg 8:14–15
  22. Tozun N, Ozdogan O, Cakaloglu Y, Idilman R, Karasu Z, Akarca U, Kaymakoglu S, Ergonul O (2015) Seroprevalence of hepatitis B and C virus infections and risk factors in Turkey: a fieldwork TURHEP study Clin Microbiol Infect 21: 1020–1026
  23. Shire NJ, Rouster SD, Rajicic N, Sherman KE (2004) Occult hepatitis B in HIV-infected patients. J Acquire Immune Defic Syndr 36:869-875
  24. Hofer M, Joller-Jemelka HI, Grob PJ, Lüthy R, Opravil M (1998) Frequent chonic hepatitis B virus infection in HIV-infected patients positive for antibody to hepatitis B core antigen only. Swiss HIV Cohort Study. Eur J Clin Microbiol Infect Dis 17:6-13

Information Menu

Popular Journals