HIV感染者中乙型肝炎病毒感染及其免疫水平分析

目的探讨艾滋病病毒(HIV)感染者中乙型肝炎病毒(HBV)的重叠感染状况以及对HBV的免疫水平。方法对59份HIV-1抗体阳性血清,采用酶联免疫吸附试验(ELISA)检测HBV表面抗原(HBsAg)和表面抗体(抗-HBs)。分析HIV感染者中HBV感染及免疫情况。结果HIV/HBV重叠感染率为13.56%(8/59),抗-HBs阳性率为55.93%(33/59)。不同性别、年龄、感染途径的HIV/HBV重叠感染率以及抗-HBs阳出率,各组之间分别比较,均无显著性差别。结论HIV/HBV重叠感染率相对较低,抗-HBs的阳性率较高,这与人群自然免疫、人工免疫有关。     

597例甲型肝炎抗—HBs检出的临床意义

本文报道了597例甲型肝炎和311例乙型肝炎HBV-M的检测结果,重点分析了甲肝病人单项抗-HDs的检出特点。甲肝抗-HBs总阳性率为63.82％,其中单项阳性率为57.48％。乙肝抗-HBs总阳性率为9.18％,但无1例单项抗-HBs阳性。甲肝抗-HBs P/N峰值≤10的为87.66％(≤5的为63.25％),均值为5.74±6.14,明显低于乙肝(18.05±26.66,P<0.001)。这种单一低效价的抗-HBs可能是非特异性反应,并不提示HBV感染的恢复或存在对HBV的免疫。     

HBsAg与抗-HBs同时阳性的慢性乙型肝炎患者临床特点分析

目的分析HBsAg与抗-HBs同时阳性的现象及其临床特点,并探讨其产生的原因。方法收集2011年2月-2014年2月东南大学附属第二医院体检者2260例,其中被诊断为慢性乙型肝炎的患者830例。采用化学发光微粒子免疫分析法筛选HBsAg与抗-HBs同时阳性的患者188例,分为HBeAg阳性组(n=101)和HBeAg阴性组(n=87)。同时选取200例HBsAg阳性、抗-HBs阴性者作为对照,其中HBeAg阳性组80例,HBeAg阴性组120例。检测HBV血清学标志物、肝功能、病毒载量并结合临床进行分析。计数资料组间比较采用χ2检验。结果 HBV血清学标志物在HBsAg与抗-HBs双阳性情况下共有5种模式,其中以HBsAg、抗-HBs、HBeAg及抗-HBc阳性,且抗-HBe阴性多见,占47.9%(90/188),肝功能指标总异常率为69.1%(130/188),HBV DNA总阳性率为56.9%(107/188)。HBeAg阳性的2组HBV DNA均存在高水平复制,其中HBsAg与抗-HBs双阳性组HBV DNA阳性率与对照组比较,差异无统计学意义(χ2=2.632,P0.05);HBeAg阴性组中,HBsAg与抗-HBs双阳性组HBV DNA定量1×105IU/ml的比例与对照组比较,差异有统计学意义(χ2=10.740,P0.05)。对HBV S区进行测序分析发现,测序的80例HBsAg与抗-HBs双阳性患者中有27例患者的HBV S区发生变异,突变率33.7%,且S区变异位点主要有P29L、S61L、P62L、I126T/S、Q129N、M133K、F134L、G145R/K、L175S和L186H等。结论 HBsAg与抗-HBs同时阳性者在乙型肝炎患者中有一定比例,其主要原因可能是病毒株变异所致。这种情况并不代表疾病好转,且抗-HBs出现并不一定能完全有效清除HBsAg,病毒DNA往往存在持续复制,需引起重视。     

甲型肝炎抗-HBs检出的临床意义

本文通过对597例甲型肝炎HBV-M 的检测,发现抗-HBs 阳性率很高。总阳性率为63.82%(381/597)。其中单项阳性率为57.48%(219/381)。与311例乙型肝炎 HBV-M 检测结果对比,抗-HBs 阳性率为9.18%,并且无1例单项抗-HBs 阳性。在     

HBsAg阴性/抗HBc阳性献血员HBV感染状况调查

目的 对431例HBsAg阴性献血员检测抗-HBc、抗-HBs,抗-HBc阳性者196例(45.5％),其中单项抗-HBc阳性者35例(17.9％),抗-HBc/抗-HBs阳性者161例(82.1％)。对抗-HBc阳性者检测抗-HBc IgM和HBV DNA(聚合酶链法),抗-HBc IgM的检出率为32.1％(63/196),其中抗-HBc/抗-HBs阳性者检出率为29.8％(48/161),单项抗-HBc阳性者检出率为42.9％(13/35),二者无差异;HBV DNA检出率为14.8％(29/196),单项抗-HBc阳性者HBV DNA检出率为25.7％,显著高于抗-HBs/抗-HBc阳性者(12.4％)(P<0.05);抗-HBc IgM阳性者HBV DNA检出率(39.7％)也显著高于抗-HBc IgM阴性者(3.0％)(P<0.001),二者阴阳性符合率则为78.6％(154/196)。HBsAg阴性/抗-HBc阳性献血员仍有传染性存在,尤以抗-HBc IgM阳性者最具血源传播HBV的危险性,因此,建议对HBsAg阴性献血员再进一步筛检抗-HBc IgM。     

乙型肝炎表面抗原和乙型肝炎e抗原双阳性的乙型肝炎病毒携带产妇进行母乳喂养的安全性

目的探讨乙型肝炎表面抗原(hepatitis B surface antigen,HBsAg)和乙型肝炎e抗原(hepatitis B e antigen,HBeAg)双阳性的乙型肝炎病毒(hepatitis B virus,HBV)携带产妇采用母乳喂养对其所生婴儿HBV感染率的影响.方法采用前瞻性队列研究方法,纳入2016年2月至2018年5月在浙江大学医学院附属妇产科医院进行产前检查及分娩的HBsAg和HBeAg双阳性携带HBV产妇及其所生的婴儿各323例,将其分为母乳喂养组和人工喂养组.采用化学发光免疫分析法和聚合酶链反应-荧光探针法,分别检测两组婴儿在出生<24 h及7月龄时的血清HBV标志物和HBV DNA的阳性率.统计学方法采用x2检验.结果最终纳入297例患者,其中母乳喂养组149例,人工喂养组148例.母乳喂养组与人工喂养组婴儿在出生<24 h及7月龄时的HBsAg、抗-HBs、HBeAg、HBV DNA>100 IU/mL的阳性率比较,差异均无统计学意义(均P>0.05).母乳喂养组出生<24 h新生儿抗-HBs阳性率为58.39%(87/149),低于7月龄时的95.97%(143/149);母乳喂养组出生<24 h新生儿HBeAg阳性率为65.10%(97/149),高于7月龄时的13.42%(20/149);差异均有统计学意义(x2=59.75、40.49,均P<0.01).母乳喂养组出生<24 h新生儿的HBsAg和HBV DNA>100 IU/mL阳性率分别为2.01%(3/149)和2.68%(4/149),其7月龄时的HBsAg和HBV DNA>100 IU/mL阳性率分别为2.68%(4/149)和2.68%(4/149),两个时间点比较差异均无统计学意义(均P>0.05).人工喂养组出生<24 h新生儿抗-HBs阳性率为47.97%(71/148),低于7月龄时的95.94%(142/148);人工喂养组出生<24 h新生儿HBeAg阳性率为55.41%(82/148),高于7月龄时的19.59%(29/148);差异均有统计学意义(x2=85.37、39.84,均P<0.01).人工喂养组出生<24h新生儿的HBsAg和HBV DNA>100IU/mL阳性率分别为4.73%(7/148)和1.35%(2/148),其7月龄时的HBsAg和HBV DNA>100 IU/mL阳性率分别为1.35%(2/148)和1.35%(2/148),两个时间点比较差异均无统计学意义(均P>0.05).结论母乳喂养不是增加HBsAg和HBeAg双阳性HBV携带产妇垂直传播风险的决定性因素,建议这类产妇在正规预防的前提下进行母乳喂养.     

673名健康志愿者乙肝疫苗免疫接种效果及影响因素分析

目的观察济宁地区普通人群20μg重组乙型肝炎疫苗(CHO细胞)免疫接种后抗-HBs转阳率,探讨疫苗免疫接种者抗-HBs转阳率的影响因素。方法 673名健康志愿者,分别于0、1、6月各接种20μg重组乙型肝炎疫苗。全程免疫后1～2个月采血,分离血清,采用ELISA法检测抗-HBs抗体,评价免疫效果,并分析年龄和性别对血清抗-HBs抗体转阳的影响。结果 673名健康志愿者接种20μg重组乙型肝炎疫苗(CHO细胞)后血清抗-HBs抗体阳性率为92.57%,不同年龄组抗体阳性率差异有统计学意义(P<0.001),男女抗-HBs抗体阳性率差异有统计学意义(P<0.001)。结论 20μg重组乙型肝炎疫苗(CHO细胞)免疫接种后血清抗-Hbs抗体阳性率较高。年龄、性别均可影响免疫接种后抗-HBs抗体转阳率。     

未抗病毒治疗人类免疫缺陷病毒感染者隐匿性乙型肝炎的调查及其临床特点

目的 观察未经抗病毒治疗(ART)的人类免疫缺陷病毒(HIV)感染者和普通人群隐匿性乙型肝炎流行状况,评估HIV感染者合并隐匿性乙型肝炎的临床特点.方法 通过酶联免疫分析法检测未经ART治疗的HIV感染者和普通人群血浆HBsAg、抗-HBs、HBeAg、抗-HBe和抗-HBc水平,筛查出HBsAg阴性的HIV感染者(感染组)249例,健康体检者HBsAg阴性者121例(健康组),再采用罗氏COBASAmpliPrep/COBAS TaqManHBVTest,version2.0试剂盒检测外周血HBV DNA水平.统计分析用STATA 10软件处理本实验各组数据.用Fisher's精确概率检验、秩和检验.结果 感染组HBV DNA阳性者24例,隐匿性乙型肝炎占9.7％;健康组HBV DNA阳性者4例,隐匿性乙型肝炎占3.3％,两组比较,P=0.035,差异有统计学意义.感染组24例HBVDNA阳性者,HBV DNA载量最低者血中能测到,但在检测值水平以下,(即＜20 IU/ml),最高者3.22×105 IU/ml.大于100 IU/ml占37.5％(9/24),20 ～ 99 IU/ml占16.7％ (4/24),＜20IU/ml,但可测出HBV DNA占45.8％ (11/24).HIV感染者抗-HBc(+)/抗-HBs(+)组、抗-HBc(+)/抗-HBs(-)组、抗-HBc(-)/抗-HBs(+)组、抗-HBc(-)/抗-HBs(-)组DNA阳性率分别为7.3％ (8/110),20.8％ (11/53),14.3％ (3/21),3.1％(2/64),抗-HBc(+)/抗-HBs(-)组分别与抗-HBc(+)/抗-HBs(+)组、抗-HBc(-)/抗-HBs(-)组两组比较,P值分别为0.018和0.003,差异有统计学意义.四组间HBV DNA病毒载量比较,P=0.805,差异无统计学意义.感染组HBV DNA(+)组与HBV DNA(-)组比较,CD4计数(Z=1.902,P=0.0586)和ALT水平(Z=1.401,P=0.1611)差异无统计学意义.结论 在未经ART治疗HIV感染者中,隐匿性乙型肝炎高于普通人群,HIV感染者抗-HBc(+)/抗-HBs(-)组隐匿性乙型肝炎最高.     

替比夫定联合HBIG和乙肝疫苗阻断HBV母婴传播临床效果分析

目的探讨应用替比夫定联合乙型肝炎高效价免疫球蛋白(HBIG)和乙肝疫苗阻断乙型肝炎病毒(HBV)母婴传播的临床效果。方法在HBV感染孕妇197例中,92例在孕7月时开始口服替比夫定至分娩后3个月,两组新生儿均接受标准HBIG和乙肝疫苗接种。随访12个月。结果研究组孕妇分娩时血清HBV DNA水平显著低于对照组(P0.05);研究组新生儿出生24h和出生1个月宫内感染率均为6.7%,显著低于对照组(分别为19.6%和22.8%,P0.05);研究组新生儿出生12个月后HBs Ag阳性率和HBV DNA阳性率分别为5.7%和0.9%,显著低于对照组(分别为19.6%和9.8%,P0.05),血清抗-HBs阳性率为94.3%,显著高于对照组的84.8%(P0.05)。结论应用替比夫定联合HBIG和乙肝疫苗能够有效抑制孕妇HBV DNA复制,降低新生儿宫内感染率,提高抗-HBs阳性率,对新生儿有良好的保护效果。     

304例阻断HBV母婴传播效果观察

目的:探讨乙肝疫苗(HepB)和高效价乙肝免疫球蛋白(HBIG)联合(以下称主被动免疫)阻断HBV母婴传播效果.方法:将宁夏平罗县304例血清HBsAg阳性孕妇及其所生婴儿作为研究对象,按孕妇血清HBeAg定性结果分为阳性组、阴性组,并对阻断结果进行分析.结果:经主被动免疫方法阻断HBV母婴传播,孕妇HBeAg阴性组阻断率达100%,HBeAg阳性组阻断率达96.51%(P＜0.05),总体阻断率达98.63%.经主被动免疫后,孕妇HBeAg阳性组婴儿12月龄抗-HBs阳转率为53.85%(56/104),孕妇HBeAg阴性组婴儿12月龄抗-HBs阳转率为58.00%(116/200)(P＞0.05),两组婴儿12月龄抗-HBs总体阳转率为56.57%.分娩方式和喂养方式不同,婴儿12月龄血清HBsAg阳性率无差别(P＞0.05).结论:主被动免疫方法阻断HBV母婴传播效果肯定.HBsAg阳性孕妇所生婴儿12月龄检查HBV-M是必要的.经主被动免疫情况后,HBeAg阳性孕妇自然分娩和母乳喂养没有增加婴儿感染HBV的危险性.     

Low rate of occult hepatitis B virus infection among anti-HBc positive blood donors living in a low prevalence region in Brazil

OBJECTIVE: The aim of this study was to determine the rate of occult hepatitis B virus (HBV) infection among blood donors living in a geographic region of low (5.6%) anti-HBc prevalence. SUBJECTS AND METHODS: Sera from 150 candidate blood donors whose blood was rejected due to total anti-HBc reactivity (despite absence of HBsAg) were tested for anti-HBs and IgM anti-HBc antibodies, as well as for HBeAg/anti-HBe. Serum HBV DNA was sought by using a PCR assay able to amplify part of the surface gene. Viral load was measured in the PCR positive samples. RESULTS: The pattern 'anti-HBc alone' (without HBsAg and anti-HBs antibodies) was found in 64 (42.7%) subjects. IgM anti-HBc and anti-HBe antibodies were detected in 2 (1.3%) and 80 (53.3%) samples, respectively. No sample was HBeAg-reactive. HBV DNA was repeatedly found in five (3.3%) samples, three of which were anti-HBs positive and two anti-HBs negative. All five HBV DNA positive samples showed a low viral load (<1000copies/ml). CONCLUSIONS: The data indicated a low rate of occult infection among anti-HBc positive, HBsAg negative blood donors living in a region of low prevalence of infection. Viral load was very low in all HBV infected subjects.     

Prevention of de novo HBV infection by the presence of anti-HBs in transplanted patients receiving core antibody-positive livers

AIM: To analyze whether the presence of anti-HBs in liver transplant recipients is effective in preventing HBV infection. METHODS: Twenty-three patients receiving anti-HBc positive liver were studied. Nine recipients were anti-HBc positive as a result of previous HBV infection. Of them, one also received HBV vaccine during the pre-liver transplantation period. Fourteen recipients were anti-HBs positive due to HBV vaccine administered during the pretransplant period. Liver biopsy was obtained in 10/14 anti-HBc negative/anti-HBs positive recipients and in 4/9 anti-HBc positive recipients. RESULTS: After a mean follow-up period of 46 months, 1 recipient with protective serum anti-HBs levels developed de novo HBV infection as a consequence of immune escape HBV mutants. Among the 14 vaccinated anti-HBc negative/anti-HBs positive recipients, 1/10 patients with available liver biopsy (10%) had liver HBV-DNA at 13 mo post-liver transplantation without serum viral markers and did not develop de novo HBV infection. The vaccinated anti-HBc positive recipient without HBV vaccine response was HBV-DNA positive in serum and liver, viral DNA was continuously negative in the following tests, so a spontaneous seroconversion was diagnosed. CONCLUSION: The presence of anti-HBs as a result of HBV vaccine or past HBV infection seems to be effective at protecting patients receiving livers from anti-HBc positive donors. However, the emergence of immune escape HBV mutants, which can evade the anti-HBs protection, should be considered as a risk of HBV infection.     

Occult hepatitis B virus among chronic liver disease patients in Yemen

ObjectiveTo estimate the rate of occult hepatitis B virus (HBV) among patients with chronic liver disease (CLD).MethodsAfter an informed consent, sera samples were collected during April 2004 to April 2005 from 280 patients (200 male and 80 female). They were previously diagnosed with CLD based on history and ultrasound and were investigated for occult HBV infection. Sera were first screened for HBsAg and those which showed negative were tested for anti-HBc. The anti-HBc positive sera were further tested for anti-HBs to identify sera with isolated anti-HBc which in turn were subjected to HBV–DNA testing using PCR to determine the rate of occult HBV infection. Moreover, sera with occult HBV were tested for Anti-HCV and HCV-RNA using RT-PCR.ResultsHBsAg was detected in 44 of 280 (15.7%). Of 236 HBsAg negative sera anti-HBc was detected in 22 (9.3%). All anti-HBc positive sera were found to be anti-HBs negative. HBV–DNA was detected in 11 of 22 (50.0%) sera with isolated anti-HBc indicating occult HBV in 4.3% of all sera. None of the sera with occult HBV had anti-HCV or HCV-RNA.ConclusionsOccult HBV infection does exist among CLD patients in Yemen and the mechanism of its occurrence merits further investigation.     

Hepatitis B virus DNA in the serum of anti-HBs positive persons]

In order to investigate the significance of HBV DNA in the serum of anti-HBs positive persons, the serum of 76 anti-HBs positive persons was studied for HBV DNA by means of polymerase chain reaction (PCR). The results showed that 21 (32.2%) out of 65 cases without hepatitis B vaccination were positive for HBV DNA detected with PCR (PCR-HBV DNA), but no one was positive for PCR-HBV DNA in 11 cases inoculated against hepatitis B. It was also found that 6 cases were positive for HBsAg-Ab immunocomplex in those positive for PCR-HBV DNA and the liver tissue in 2 of the 5 cases with liver-biopsy were positive for HBVAg determined with immunohistologic ABC method. We believed that persons, who acquired anti-HBs after HBV infection were different from those who were vaccinated, might carry HBV which come from the HBsAg-Ab immunocomplex and HBVAg positive hepatocytes. In addition, the study also proved that the PCR-HBV DNA positive rate correlated significantly with the anti-HBe and or anti-HBc positive rate and with the abnormal rate of liver function in the anti-HBs positive persons. It was suggested that persistent presence of HBV DNA in the bodies should be responsible for the persistent presence of anti-HBe and anti-HBc in the serum and also for the liver damage.     

Response to hepatitis B vaccine in HIV-1-positive subjects who test positive for isolated antibody to hepatitis B core antigen: implications for hepatitis B vaccine strategies

BACKGROUND: Whether human immunodeficiency virus type 1 (HIV-1)-positive subjects who test positive for isolated antibody to hepatitis B core antigen (anti-HBc) should be vaccinated with hepatitis B vaccine is not certain. Development of an anamnestic response after vaccination would suggest previous hepatitis B virus (HBV) infection, in which case vaccination is not necessary. METHODS: Sixty-nine HIV-1-positive subjects who tested negative for hepatitis B surface antigen (HBsAg) and antibody to HBsAg (anti-HBs) received vaccination with standard hepatitis B vaccine. Twenty-nine subjects (42%) tested positive for anti-HBc, and 40 (58%) tested negative for anti-HBc. An anamnestic response was defined as an anti-HBs titer of >or=10 IU/L within 4 weeks of the first vaccination. RESULTS: The overall anamnestic response rate was 16% and was not significantly different between subjects who tested positive for anti-HBc (24%) and those who tested negative for anti-HBc (10%) before vaccination (P=.18). Approximately 50% of subjects who tested positive for anti-HBc also tested positive for antibody to hepatitis Be antigen (anti-HBe). The anamnestic response rate was higher in subjects who tested positive for both anti-HBc and anti-HBe (43%) than in subjects who tested positive for anti-HBc but negative for anti-HBe (7%) (P=.035). After a complete series of vaccinations, HIV-1/hepatitis C virus (HCV)-coinfected subjects were less likely to achieve high anti-HBs titers than were subjects infected with HIV-1 alone. CONCLUSIONS: After hepatitis B vaccination, the anamnestic response rate in HIV-1-positive subjects who tested positive for isolated anti-HBc but negative for anti-HBe was low and was comparable to that in subjects who tested negative for anti-HBc. This finding suggests that testing for anti-HBc alone may not be a reliable assessment of protection from HBV infection. HIV-1/HCV coinfection may be associated with impaired responses to hepatitis B vaccine, and evaluation of strategies to improve immunogenicity of the vaccine in such individuals is warranted.     

重庆地区无偿献血人群隐匿性乙型肝炎病毒感染的特征

目的了解重庆地区无偿献血人群中隐匿性乙型肝炎病毒感染(occult hepatitis B virus infection,OBI)情况,分析其血清学和病毒学特征。方法应用酶联免疫法(筛查HBs Ag、抗-HCV、抗-HIV)及核酸检测(nucleic acid testing,NAT)法(筛查HBV、HCV、HIV)筛查重庆地区93 625份初筛合格的无偿献血者血液标本。对其中HBs Ag(-)但HBV DNA(﹢)的标本进行抗-HBs、抗-HBc、HBe Ag、抗-HBe 4项血清学标志物测定,进一步对抗-HBc(﹢)标本做病毒载量测定以及基因分型。结果 93 625份标本中HBs Ag(-)但HBV DNA(﹢)的检出率为0.097%(91/93 625)。91份阳性标本中79份为抗-HBc(﹢),检出率为0.084%(79/93 625)。该部分标本阳性者被视为OBI献血者。OBI献血者的血清学特征可以分为4种模式:单抗-HBc(﹢)、抗-HBc(﹢)/抗-HBs(﹢)、抗-HBc(﹢)/抗-HBe(﹢)以及抗-HBc(﹢)/抗-HBs(﹢)/抗-HBe(﹢)。病毒载量为0~1056.8IU/ml(中位数为108.6 IU/ml),基因型以B型为主。结论重庆地区无偿献血者中OBI检出率较高,其血清学和病毒学特征具有地区性。NAT能提高OBI检出的灵敏度,但也存在一定的假阳性,对血液安全具有重要影响。     

The relationship of hepatitis B virus infection between adults and their children in Guangxi Province, China

BACKGROUND/AIM: This study aimed to describe the seroepidemiology of hepatitis B virus (HBV) infection, with emphasis on transmission of HBV infection between adults and their children. METHODS: We analyzed the hepatitis sero-survey data collected from 2132 persons aged 1-59 years (624 families) in Guangxi Province, China, 1992. Blood was tested for the presence of the hepatitis B surface antigen (HBsAg), the antibody to hepatitis B core antigen (anti-HBc), and the antibody to hepatitis B surface antigen (anti-HBs). RESULTS: Of the 2132 persons surveyed, 119 (5.6%) reported receiving HBV vaccination. Among those persons who did not receive HBV vaccination, 19% were HBsAg positive (current HBV infection) and 57% had a past HBV infection (they were HBsAg negative and either anti-HBc positive or anti-HBs positive). Among 519 children aged 1-10 years who did not receive HBV vaccination, 21% had current HBV infection and 37% had past HBV infection. Among 289 children of both parents who were HBsAg negative, 16% had current HBV infection and 36% had past HBV infection. CONCLUSIONS: The high prevalence of community-acquired HBV infection in children and the low HBV vaccination coverage in Guangxi should alert public health agencies to re-examine their current policies for preventing HBV transmission.     

无偿献血人群隐匿性乙型肝炎病毒感染调查*

目的 调查无偿献血人群隐匿性乙型肝炎病毒感染(OBI)情况。方法 2021年1月～2021年12月我站无偿献血者血液样本107397份,采用两种ELISA法检测试剂盒进行HBsAg的初次筛查,采用核酸检测(NAT)法对两次HBsAg结果均为阴性的样本进行HBV DNA检测。对血清HBsAg阴性而HBV DNA阳性样本进行HBV血清学标志物检测,并采用实时荧光定量聚合酶链式反应(PCR)法检测核酸和病毒基因分型。 结果 在筛查的107397例无偿献血人群血样本中,经血清标志物检测后确认为OBI 者29例(0.27‰);血清抗-HBc阳性者12例(35.3%),抗-HBe/抗-HBc阳性者8例(23.5%),抗-HBs/抗-HBc阳性者6例(17.7%),抗-HBs/抗-HBe/抗-HBc阳性者3例(8.8%);19～29岁年龄段献血人群OBI感染率为0.09‰,30～39岁人群为0.32‰,40～49岁人群为0.39‰,50～55岁年龄段献血人群OBI感染率为0.41‰,且该年龄段重复献血者OBI感染率为0.31‰;血清抗-HBs/抗-HBc阳性和抗-HBs/抗-HBe/抗-HBc OBI献血者血清病毒载量>1000 IU/mL的占比分别为33.3%和66.7%,显著高于血清仅抗-HBc阳性者(0.0%,P<0.05)或血清抗-HBe/抗-HBc阳性者(0.0%,P<0.05);在29例OBI献血者中,C基因型占比为62.1%,B基因型感染占比为27.6%。结论 在初筛血清HBsAg 阴性的献血人群中,可能还存在很低比率的OBI人群,对用血安全提出了挑战。全面进行病毒核酸检测的花费-效益关系需要认真研究,提高常规ELISA检测方法的灵敏度也是关键。     

Prevalence, patterns, and course of past hepatitis B virus infection in intravenous drug users with HIV-1 infection

OBJECTIVE: Hepatitis B virus (HBV) and human immunodeficiency virus (HIV) share common routes of transmission. Therefore, markers of either active or past HBV infection are present in many HIV-infected patients, particularly in intravenous drug users (IDUs). The aim of this study was to analyze the serological pattern of past HBV infection (presence or absence of anti-HBs) and the course of past HBV infection (changes in anti-HBs status, and HBV reactivation) in two cohorts of IDUs with and without HIV infection. METHODS: HBV serum markers were studied in 388 HIV-positive and 197 HIV-negative IDUs. Among them, 263 HIV-positive and 50 HIV-negative patients with past HBV infection (serum HBsAg negative and anti-HBc positive, with or without anti-HBs) were followed-up for a median of 21 and 13 months, respectively, to detect changes in anti-HBs status and HBV reactivation. RESULTS: The prevalence of HBV infection (either active or past) was higher in HIV-positive than in HIV-negative cases (90% vs 62%, p < 0.001), even when stratified by years of drug use. Most cases (92% of HIV-positive and 89% of HIV-negative) had markers of past infection. Among those patients with past HBV infection, 60% of HIV-positive and 72% of HIV-negative presented serum anti-HBs (p = 0.03). The incidence of anti-HBs loss was 1.8 cases/100 person-year in HIV-positive, and 1.8 cases/100 person-year in HIV-negative patients (RR 1.0, 95% CI 0.1-94, p = NS). Incidence of anti-HBs development was 17.6 cases/100 person-year in HIV-positive and 25.6 cases/100 person-year in HIV-negative IDUs (RR, 1.5, 95% CI, 0.6-3.5, p = NS). Only one HIV-positive patient with markers of past HBV infection developed an active infection (0.2 events/100 person-year). CONCLUSIONS: HBV infection (either active or past) is particularly frequent in HIV-positive IDUs. Most cases have markers of past infection. Isolated detection of anti-HBc (absence of anti-HBs) is more common in HIV-positive than in HIV-negative IDUs. Despite their progressive immunosuppression, both anti-HBs loss and HBV reactivation are rare in HIV-infected IDUs.