The prevalence of occult HBV infection in hemodialysis patients with chronic HCV infection

Öz

Background/aim: Occult hepatitis B virus (HBV) infection is defined by the existence of HBV infection in which HbsAg cannot be determined. It is reported that the prevalence of occult HBV infection is high in chronic hepatitis C, HCC and hemodialysis patients, in patients having cryptogenic liver disease, in drug-injection users and those with HIV, as well as in those patients with blood transfusion and in blood donors. In this study, we aimed to investigate the prevalence of occult HBV infection in hemodialysis patients with chronic HCV and to establish its clinical effects. Materials and methods: A total of 50 chronic hemodialysis patients whose HbsAg was negative and anti-HCV positive were included in the study. According to the results of HCV-RNA polymerase chain reaction (PCR), these patients were divided into two groups: HCVRNA positive and HCV-RNA negative. In both groups, HBV-DNA was investigated by sensitive PCR method. Results: HBV-DNA could not be determined by PCR method in any of 22 patients in the HCV-RNA positive group and of 28 patients in the HCV-RNA negative group. The mean age of patients was 47.2±17 in the HCV-RNA positive group and 39.6±15.6 in the HCV-RNA negative group. Conclusion: The prevalence of occult HBV infection in hemodialysis patients with chronic HCV was determined not to be high in our area. This result in our study should be further evaluated by taking into account the interaction of HbsAg positivity rate (8-10%) with the prevalence of HBV mutants in the region. In addition, it is necessary to revise the sensitivity and specificity of still non-standardized HBV-DNA PCR methods and determine a common diagnosis method accordingly.

Anahtar Kelimeler

• Chronic HCV, hemodialysis, occult HBV infection

Kronik HCV'li hemodiyaliz hastalarında occult HBV infeksiyonu sıklığı

Öz

Giriş ve amaç: Occult HBV infeksiyonu, HBsAg'nin tespit edilemediği HBV infeksiyonun varlığı ile tanımlanır. Kronik hepatitis C, HCC ve hemodiyaliz hastalarında, kriptojenik karaciğer hastalığı olanlarda, ilaç injeksiyon kullanıcıları ve HIV'lilerde, ayrıca sık kan transfüzyonu yapı- lanlar ve kan donörlerinde occult HBV infeksiyonunun prevalansının yüksek olduğu belirtilmektedir. Biz bu çalışmada, kronik HCV'li hemodiyaliz hastalarındaki occult HBV infeksiyonun prevalansını ve klinik etkilerini araştırmayı hedefledik. Gereç ve yöntem: HBsAg'si negatif, anti-HCV'si pozitif olan 50 kronik hemodiyaliz hastası çalışmaya alındı. Bu hastalar HCV-RNA PCR sonuçlarına göre HCV-RNA pozitif ve HCV-RNA negatif olarak iki gruba ayrıldı. Her iki hasta grubunda HBVDNA duyarlı PCR yöntemi ile araştırıldı. Bulgular: HCV-RNA pozitif 22 hasta ve HCV-RNA negatif 28 hasta gruplarının hiçbirinde serumda PCR yöntemi ile HBV-DNA tespit edilemedi. Hastaların ortalama yaşları HCV-RNA pozitif grupta 47.2±17 ve HCV-RNA negatif grupta 39.6±15.6 idi. Sonuç: Bölgemizde, kronik HCV'li hemodiyaliz hastaları nda occult HBV infeksiyonu prevalansı yüksek değildir. Çalışmamızdaki bu sonucu, bölgemizdeki HBsAg pozitiflik oranı (%8-10) ile HBV mutantlarının görülme sıklığının etkileşimini dikkate alarak değerlendirmek gerekir. Ayrıca, halen standardize edilmemiş HBV-DNA PCR yöntemlerinin sensitivite ve spesifitelerini de gözden geçirmenin ve buna göre ortak bir tanı yöntemi tanımlamanın gerekliliği ortaya çıkmaktadır.

Anahtar Kelimeler

• Kronik HCV, hemodiyaliz, occult HBV infeksiyonu

Kaynakça

1. Hu KQ. Occult hepatitis B virus infection and its clinical implicati- ons. J Viral Hepat 2002; 9(4): 243-257.
2. Marrero JA, Lok AS. Occult hepatitis B virus infection in patients with hepatocellular carcinoma: Innocent bystander, cofactor or culprit? Gastroenterology 2004; 126(1): 347-350.
3. Allain JP. Occult hepatitis B virus infection: implications in trans- fusion. Vox Sang 2004; 86(2): 83-91.
4. Allain JP. Occult hepatitis B virus infection. Transfus Clin Biol 2004; 11(1): 18-25.
5. Toyoda H, Hayashi K, Murakami Y et al. Prevalence and clinical implications of occult hepatitis B viral infection in hemophilia pati- ents in Japan. J Med Virol 2004; 73(2): 195-199.
6. Oesterreicher C, Hammer J, Koch U, et al. HBV and HCV genome in peripheral blood mononuclear cells in patients undergoing chro- nic hemodialysis. Kidney Int 1995; 48(6); 1967-1971.
7. Torberson M, Kannangani R, Astemorski J, et al. High prevalence of occult hepatitis B in Baltimore injection drug users. Hepatology 2004; 39(1); 51-57.
8. Shire NJ, Rouster SD, Rajicic N, et al. Occult hepatitis B in HIV-in- fected patients. J Acquir Immune Defic Syndr. 2004; 36(3): 869- 875.

9. Khan MH, Farrell GC, Byth Ket, et al. Which patients with hepati- tis C develop liver complication? Hepatology 2000; 31: 513-520.
10. Fukuda R, Ishmiraa N, Niigaki Met, et al. Serologically silent hepa- titis B virus coinfection in patients with hepatitis C virus-associated chronic liver disease: clinical and virological significance. J Med Virol 1999; 58: 201-207.
11. Cacciola I, Pollicino T, Squadrito G, et al. Occult hepatitis B virus infection in patients with chronic hepatitis C liver disease. N Engl J Med 1999; 341: 22-26.
12. Gaeta GB, Rapicetta M, Sardaro C, et, et al. Prevalence of anti- HCV antibodies in patients with chronic liver disease and its relati- onship to HBV and HDV infections. Infection 1990; 18: 277-279.
13. Kazemi-Shirazi L, Peterman D, Muller C. Hepatitis B virus DNA in sera and liver tissue of HbsAg negative patients with chronic hepa- titis C. J Hepatol 2000; 33: 785-790.
14. Villa E, Crottola A, Buttafoco P, et al. Evidence for hepatitis B vi- rus infection in patients with chronic hepatitis C with and without serological markers of hepatitis B. Dig Dis Sci. 1995; 40: 8-13.
15. Uchida T, Kaneita Y, Gotoh K, et al. Hepatitis C virus is frequently coinfected with serum marker-negative hepatitis B virus; probable replication promotion of the former by the latter as demostrated by in vitro cotransfection. J Med Virol 1997; 52: 399-405.
16. Zignego AL, Fontana R, Puliti S, et al. Impaired response to alpha interferon in patients with an inapparent hepatitis B and hepatitis C virus coinfection. Arch Virol 1997; 142: 535-544.
17. Ferraro D, Bonura C, Giglio M, et al. Occult HBV infection and supression of HCV repilacation in the early phase of combination therapy for chronic hepatitis C. J Biol Regul Homeost Agents 2003; 17(2): 172-175.
18. Giannini E, Ceppa P, Botta F, et al. Previous hepatitis B virus in- fection is associated with worse disease stage and occult hepatitis B virus infection has low prevalence and pathogenicity in hepatitis C virus-positive patients. Liver Int 2003; 23(1): 12-18.
19. Fabris P, Brown D, Tositti G, et al. Occult hepatitis B virus infecti- on does not affect liver histology or response to therapy with inter- feron alpha and ribavirin in intravenous drug users with chronic he- patitis C. J Clin Virol 2004; 29(3): 160-166.
20. Paterlini P, Gerken G, Nakajima E, et al. Polymerase chain reacti- on to detect hepatitis B virus DNA and RNA sequences in primary liver cancers from patients negative for hepatitis B surface antigen. N Engl J Med 1990; 323: 80-85.
21. Barasin C, Betes M, Panizo A, et al. Pathological and virological findings in patients with persistent hypertrasaminasemia of unk- nown aetiology. Gut 2000; 47: 429-435.
22. Lau GK, Wu PC, Liang R, et al. Persistence of hepatitis B virus af- ter serological clearance of HbsAg with autologous peripheral stem cell transplantation. J Clin Pathol 1997; 50: 706-708.
23. Iwai K, Tashima M, Itoh M, et al. Fulminant hepatitis B following bone marrow transplantation in an HbsAg-negative, HbsAb-positi- ve recipient; reactivation ofb dormant virus during the immuno- suppressive period. Bone Marrow Transplant 2000; 25: 105-108.
24. Wright Tl, Mamish D, Combs C, et al. Hepatitis B virus and appa- rent fulminant non-A, non-B hepatitis. Lancet 1992; 339: 952-955.
25. Hytiroglou P, Dash S, Haruna Y, et aal. Detection of hepatitis B and hepatitis C viral sequences in fulminant hepatic failure of unknown etiology. Am J Clin Pathol 1995; 104: 588-593.
26. Teo E-K, Ostapowicz G, Hussain M, et al. Hepatitis B infection in patients with acute liver failure in the United States. Hepatology 2001; 33: 972-976.
27. Besisik F, Karaca C, Akyuz F, et al. Occult HBV infection and YMDD variants in hemodialysis patients with chronic HCV infecti- on. J Hepatol 2003; 38(4): 526-528.