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World J Hepatol. Feb 27, 2015; 7(2): 253-260
Published online Feb 27, 2015. doi: 10.4254/wjh.v7.i2.253
Occult hepatitis B virus co-infection in human immunodeficiency virus-positive patients: A review of prevalence, diagnosis and clinical significance
Angelica Maldonado-Rodriguez, Ana Maria Cevallos, Othon Rojas-Montes, Karina Enriquez-Navarro, Ma Teresa Alvarez-Muñoz, Rosalia Lira
Angelica Maldonado-Rodriguez, Othon Rojas-Montes, Karina Enriquez-Navarro, Ma Teresa Alvarez-Muñoz, Rosalia Lira, Unidad de Investigacion Medica en Enfermedades Infecciosas y Parasitarias, Hospital de Pediatria, Centro Medico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, 06720 Mexico City, Mexico
Ana Maria Cevallos, Departamento de Biologia Molecular y Biotecnologia, Instituto de Investigaciones Biomedicas, Universidad Nacional Autonoma de Mexico, 06720 Mexico City, Mexico
Author contributions: All the authors contributed to the manuscript.
Supported by Consejo Nacional de Ciencia y Tecnologia, Mexico (CONACYT 2008-C01-86717; to RL).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Rosalia Lira, PhD, Unidad de Investigacion Medica en Enfermedades Infecciosas y Parasitarias, Hospital de Pediatria, Centro Medico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Cuauhtemoc 330 Col. Doctores, 06720 Mexico City, Mexico. rolica36@yahoo.com
Telephone: +52-55-56276940 Fax: +52-55-56276949
Received: August 29, 2014
Peer-review started: August 29, 2014
First decision: September 28, 2014
Revised: October 22, 2014
Accepted: November 17, 2014
Article in press: November 19, 2014
Published online: February 27, 2015
Abstract

The prevalence of human immunodeficiency virus (HIV) and hepatitis B virus (HBV) co-infection is high as they share similar mechanisms of transmission. The development and widespread use of highly sensitive tests for HBV diagnosis has demonstrated that a significant proportion of apparently healthy individuals with evidence of exposure to HBV continue to carry fully functional HBV DNA in their hepatocytes, a situation that predisposes them to the development of progressive liver disease and hepatocellular carcinoma. The presence of co-infections frequently influences the natural evolution of each of the participating infections present by either facilitating their virulence or competing for resources. Furthermore, the drugs used to treat these infections may also contribute to changes in the natural course of these infections, making the analysis of the impact of co-infection more difficult. The majority of studies has examined the impact of HIV on overt chronic hepatitis B, finding that co-infection carries an increased risk of progressive liver disease and the development of hepatocellular carcinoma. Although the effect of HIV on the natural history of occult hepatitis B infection (OBI) has not been fully assessed, all available data suggest a persisting risk of repeated flares of hepatitis and progressive liver disease. We describe studies regarding the diagnosis, prevalence and clinical significance of OBI in HIV-positive patients in this short review. Discrepancies in worldwide prevalence show the urgent need for the standardization of diagnostic criteria, as established by the Taormina statements. Ideally, standardized protocols for testing should be employed to enable the comparison of data from different groups. Additional studies are needed to define the differences in risk for OBI without HIV and in HIV-HBV co-infected patients with or without overt disease.

Keywords: Hepatitis B virus, Occult hepatitis B, Human immunodeficiency virus, Prevalence, Diagnosis, Clinical significance

Core tip: The prevalence of human immunodeficiency virus (HIV) and hepatitis B virus (HBV) co-infection is high. However, as HBV infection may be occult, its diagnosis requires the routine use of highly sensitive tests. Although viral load or replication in these patients is low, they still have an increased risk of viral reactivation, chronic liver disease and hepatocellular carcinoma development. The majority of our knowledge on occult hepatitis B infection is derived from studies performed in patients with mono-infection or with HIV co-infection. This review summarizes the latest contributions in the field, clearly revealing that more studies are needed to evaluate the full impact of HIV in patients with occult HBV disease.