Abstract
Changes in serologic status in human immunodeficiency virus (HIV)/hepatitis B virus (HBV) co‐infected individuals with either isolated anti‐HBc or resolved HBV infection have been reported, but the frequency of clinically meaningful long‐term serologic changes is not well‐defined. This study therefore, examined longitudinal serologic status for hepatitis B surface antigen (HBsAg)‐negative HIV/HBV co‐infected participants in a large cohort. Among 5,222 cohort participants, 347 (7%) were initially isolated anti‐HBc positive, and 1,073 (21%) had resolved HBV infection (concurrently reactive for anti‐HBc and anti‐HBs). Thirty‐three (10%) of the 347 participants with isolated anti‐HBc were later positive for HBsAg at least once, compared with 3 (0.3%) of those with resolved HBV (P < 0.001). A total of 14 participants became persistently positive for HBsAg and were thus classified as having late‐onset chronic HBV infection at a median of 3.7 years after initial HBV diagnosis. For those initially with HBsAg‐negative HIV/HBV co‐infection, the rate of late‐onset chronic HBV infection was 1.39/1,000 person‐years. Those with late‐onset chronic HBV infection experienced significant decreases in CD4 cell counts (P = 0.002) with a mean of 132 cells/µl at the time of late‐onset chronic HBV infection, but no factor distinguished those who were positive for HBsAg only once from those that developed late‐onset chronic HBV infection. Over a median of 2.9 years following late‐onset chronic HBV infection, 3 of 14 subsequently lost HBsAg. The occurrence of late‐onset chronic HBV infection in HBsAg negative HIV/HBV co‐infected adults appears to be one important, albeit rare, clinical event seen almost exclusively in those with isolated anti‐HBc and low CD4 cell count. J. Med. Virol. 83:1537–1543, 2011. © 2011 Wiley‐Liss, Inc.