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419 Prevalence of Occult Hepatitis B Infection among HIV infected patients at an inner city clinic

Saturday, March 20, 2010
Grand Hall (Hyatt Regency Atlanta)
Rajat Nog, MD , Columbia University Medical Center affiliation at Harlem Hospital Center, New York, NY
Kumara Singaravelu, MD , Columbia University Medical Center affiliation at Harlem Hospital Center, New York, NY
Aliya Haider, MD , Columbia University Medical Center affiliation at Harlem Hospital Center, New York, NY
Vel Sivapalan, MD, FACP , Harlem Hospital Center / Columbia University, New York, NY
Sharon Mannheimer, MD , Harlem Hospital Center / Columbia University, New York, NY
Background: Morbidity and mortality is higher in HIV/HBV coinfected patients compared to monoinfected patients. Occult HBV infection i.e. Hepatitis B surface Antigen (HBs Ag) and surface antibody (HBsAb) negative but a positive Hepatitis B core antibody (anti HBc) with HBV DNA is a marker of chronic HBV infection and impacts HIV management. Testing of HBV DNA in HIV patients with isolated anti HBc positive is recommended to determine chronic infectivity and should be routinely performed.

Objective: To determine the prevalence and patient characteristics of occult hepatitis B infection in HIV infected patients attending an outpatient HIV clinic in New York.

Methods: An electronic database of 630 HIV positive patients being followed at NYC Harlem Hospital Center’s Infectious Diseases clinic between June 2007  to  Jan 2009 was reviewed. A total of 82 patients with serum HBV panel showing HBsAg-,HBsAb -, anti HBc+ were identified.Of these 57 (69.5 %) had HBV DNA testing information. Demographic variables, information on Hepatitis C antibody (HCV Ab), antiretroviral therapy (ARV), CD4 and HIV viral load was also collected. Data were analyzed using EpiInfo.

Results: Among the final study population, majority were males (n=36, 63.2%), African American (n=34, 59.6%), mean age of 48.7 ± 6.2yrs, on ARV (n=39, 70.2%), had CD4 > 200 (n=44, 77.2%) had VL < 50 (n=30, 52.6%) and also tested positive for HCV (n=27, 47.4%). Approximately 7% (n=4) of the study population met the definition of occult HBV infection. 22% (95% CI 19.5-43.6%) of patients not on ARV (n=18) had positive HBV DNA, whereas none of the patients on ARV (100%, n=39) had HBV DNA (p=0.007). All patients on ARV (n=39) were on a regimen that had  one or more medications with HBV activity.Of those with occult HBV infection, 50% (n=2) were males, 100% (n=4) were African American, mean CD4 count was 408± 280, 75% (n=3) had HIV viral load > 50 and 100% (n=4) were not on ARV.  

Conclusions: Though the overall prevalence of occult HBV (7%) in our community clinic is lower than the historical prevalence of 11%, the proportion of study patients with occult infection not on ARV (per recommended treatment guidelines) was markedly high (22%) and concerning. Therefore it could be inferred that in HIV patients not on ARV, the prevalence of occult HBV could be higher due to lack of testing. Further, a high proportion of patients with isolated anti HBc also tested positive for HCV ab (47.4%) which may be due to the effect of HCV on HBV serology. Therefore clinicians should have a high index of suspicion for occult HBV among HIV infected patients whose hepatitis panel is positive only for core antibody. This supports the recommendation of obtaining HBV DNA in such patients to diagnose chronic HBV.