الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Hepatitis B, a potentially life-threatening liver infection caused by HBV is a major global health problem. Of the two billion people infected with the virus, more than 240 million are chronic carriers,and more than 686,000 die annually from HBV-related complications, including cirrhosis and HCC. A growing body of evidence is emerging showing that the prevalence of HBV is significantly higher amongst HIV positive individuals, presumably because of the shared transmission risks and risk factors.HIV generally accelerates the natural course of HBV infection and facilitates faster progression of liver disease to cirrhosis and HCC.
In the advent of molecular diagnostics, it has been shown that a number of individuals may harbor HBV-DNA at very low levels in their liver and/or serum despite the absence of detectable HBsAg by currently available assays. This is termed OBI, characterized by the presence of HBV DNA in the blood and liver in HBsAg-negative individuals, who may or may not have anti-HBc and anti-HBs
The aim of this study was to investigate OBI infections in HIV positive patients, by detecting HBsAg, and anti HBc among them and testing those who are negative for HBsAg and positive for sole anti-HBc for the presence of HBV DNA. Also to estimate the CD4 cell count of the HIV infected patients.
The current study was carried out on 197 HIV infected patients attending Alexandria Fever Hospital for treatment and follow up. An informed consent was obtained from recruited patients followed by withdrawing of blood samples for the required investigations. A questionnaire sheet was completed for each patient. Patients were screened for the following markers by ELISA technique: HBsAg, anti HBs and anti HBc. Patients with sole anti HBc marker were screened for HBV DNA by nested PCR. In addition, all HIV patients were tested for their CD4 count by flow cytometry.
The main results of the study are:
1- HIV patients were in the age range of 3-67 years with mean age 35.41 years, 124 (62.94%) were males and 73 (37.06%) were females. Regarding the marital status; 116 (58.88%) were single. No statistically significant difference was found neither between age nor the marital status or sex and HBV markers.
2- According to vaccination, 147 (74.62%) were non-vaccinated, and 50 (25.38%) were vaccinated. Anti HBs was positive in 70 (35.53%) HIV infected patients. Anti-HBs positivity was significantly higher among those giving no history of HBV vaccination.
3- HBsAg was detected in 13 (6.60%) of HIV patients, from those 5 (2.54%) had HBsAg as the sole HBV marker.
4- Anti-HBc was detected in 82 (41.62%) of the studied HIV cases. Thirty-nine (19.80%) patients were with dual anti HBc and anti HBs. This result was statistically significant.
5- Sole anti-HBc was detected in 35 (17.77%) of patients, out of them, 7 (20%) were positive for HBV DNA indicating OBI
6- Among the 7 OBI patients, only one (14.29%) was vaccinated, and 6 (85.71%) were males.
7- CD4 count in OBI patients was in the range of 26-967 cells/mm3, with CD4 mean of 365.14. Most of patients with OBI had CD4 count less than 500 cells/mm3. Patients positive for HBsAg had mean CD4 count lower than those negative for HBsAg (266.77 vs. 506.92, respectively). In contrast, anti HBs and anti HBc positive patients had mean CD4 count higher than the patients negative for these markers. CD4 mean was 589.83 vs. 436.09 for anti HBs and 525.46 vs. 466.20 for anti HBc.
from this study, it could be concluded that:
1. OBI was detected in one fifth of HIV patients with sole anti-HBc.
2. Most of the OBI patients were non-vaccinated against HBV, and most of them were males.
3. The presence of OBI was not statistically related to studied variables.
4. There was no significant statistical relation between the presence of OBI and CD4 count, although most of them had CD4 count less than 500 cells/mm3.
5. There was a statistical significance as regards the dual presence of anti HBc and anti HBs.
6. Anti HBs positive HIV patients were negative for HBsAg denoting protection against chronic infection.
7. More than two thirds of the total population studied were nonvaccinated against HBV.