Evolution of hepatitis B serological markers in HIV coinfected patients: a case study

ABSTRACT OBJECTIVE To describe the evolution of serological markers among HIV and hepatitis B coinfected patients, with emphasis on evaluating the reactivation or seroreversion of these markers. METHODS The study population consisted of patients met in an AIDS Outpatient Clinic in São Paulo State, Brazil. We included in the analysis all HIV-infected and who underwent at least two positive hepatitis B surface antigen serological testing during clinical follow up, with tests taken six months apart. Patients were tested with commercial kits available for hepatitis B serological markers by microparticle enzyme immunoassay. Clinical variables were collected: age, sex, CD4+ T-cell count, HIV viral load, alanine aminotransferase level, exposure to antiretroviral drugs including lamivudine and/or tenofovir. RESULTS Among 2,242 HIV positive patients, we identified 105 (4.7%) patients with chronic hepatitis B. Follow up time for these patients varied from six months to 20.5 years. All patients underwent antiretroviral therapy during follow-up. Among patients with chronic hepatitis B, 58% were hepatitis B “e” antigen positive at the first assessment. Clearance of hepatitis B surface antigen occurred in 15% (16/105) of patients with chronic hepatitis B, and 50% (8/16) of these patients presented subsequent reactivation or seroreversion of hepatitis B surface antigen. Among hepatitis B “e” antigen positive patients, 57% (35/61) presented clearance of this serologic marker. During clinical follow up, 28.5% (10/35) of those who initially cleared hepatitis B “e” antigen presented seroreversion or reactivation of this marker. CONCLUSIONS Among HIV coinfected patients under antiretroviral therapy, changes of HBV serological markers were frequently observed. These results suggest that frequent monitoring of these serum markers should be recommended.

Co-infecções Aids e Hepatite B e C / Co-infections Aids and Hepatitis B and C

Esta edição , que anuncia a Mesa Redonda sobre Co-infecçoes AIDS e Hepatite B e C, não só nos convida a fazer uma série de reflexões, como acabou transformando-se em uma verdadeira aula sobre a situação atual em nosso País, com propostas para a ação individual e coletiva do Setor Saúde como um todo. O local nao poderia ser mais feliz, o recem-inaugurado Centro de Pesquisa em Saúde, o CEPES, da Faculdade de Medicina do ABC. Os Drs. David Uip, Hoel Sette Jr., Roberto Focaccia e Maria Cassia Mendes Correa, além do altissimo nível dos debates, mantiveram durante toda a reunião uma atitude ousada, provocativa, questionando os seus próprios conhecimentos cientifícos com a sua vivência, do seu dia a dia na linha de frente da luta contra a AIDS e a hepatite. Podemos afirmar que ao término da reunião, todos os presentes sentiam que não se encerrava um debate, mas sim que algo novo começava a ser criado. Os debatedores não se limitaram a fazer as suas conclusões finais, mas plantaram idéias fundamentais que, sem duvida, vão nortear as açoes futuras que se fazem necessarias para colocar o nosso País, mais uma vez, em posição de destaque no campo da Medicina