Özet

Amaç: Occult hepatit B virüs enfeksiyonu, serumda hepatit B virüs yüzey antijeni (HBsAg) yokluğuna karşın, hepatit B virus (HBV) DNA pozitifliğinin olması şeklinde tanımlanır. Biz, hepatit C virüs (HCV) enfeksiyonu olan, HBsAg negatif programlı hemodiyaliz hastalarında, occult HBV prevalansını araştırdık.
Gereç ve Yöntem: Programlı hemodiyalize giren, HBsAg negatif, anti-HCV pozitif, 40 hasta çalışmaya alındı. Hastaların karaciğer enzimleri, anti-HCV, HBsAg, anti-HBs, HBeAg, anti-HBe, anti-HBc total, anti-HBc IgMve HBV-DNA düzeyleri için periferik venöz kan örnekleri alındı. HBV-DNA tayini için Versant HBV DNA 3.0 assay Bayer, (USA) kiti kullanıldı.
Bulgular: Hastaların 21 tanesi kadın, 19 tanesi erkekti. Yaş aralığı arasında 33-83 olup, ortalama yaş 55.0± 12.4 idi. 1 hasta hariç; tüm hastaların karaciğer enzimleri normaldi. 40 hastanın 37 tanesinde anti-HBs pozitifken, 2 hastada HBV’ye ait tüm serolojik belirteçler negatif olarak bulundu. 11 hastada izole anti-HBs pozitifliği saptandı. 26 hastada anti-HBc total pozitifken; izole anti-HBc total pozitifliği hiçbir hastada saptanmadı. Anti-HCV pozitif, HBsAg negatif 40 hastanın 1 (%2. 5) tanesinde HBVDNA pozitif bulundu. HBV-DNA tespit edilen vakada anti-HBs ve anti-HBc total pozitifti.
Sonuç: Occult HBV enfeksiyonu, anti-HCV pozitif programlı hemodiyaliz hastalarında sıktır. Ancak, bunun nedeni ve klinik önemi hala tam olarak bilinmemektedir. İzole anti-HBc, anti-HBc IgM, HBeAg ve anti-HBe pozitifliklerinin; occult HBV enfeksiyonunun erken bir göstergesi olabileceği akılda tutulmalıdır.
Anahtar Kelimeler: Hemodiyaliz, Hepatit B virüs enfeksiyonu, Hepatit C virüs enfeksiyonu, Kronik böbrek yetmezliği, Occult hepatit B virüs enfeksiyonu

Prevalence of Occult Hepatitis B Virus Infection in Hemodialysis Patients with Hepatitis C Virus

Aim: Occult hepatitis B virus (HBV) infection is defined as the detection of HBV DNA in the serum of individuals whose tests were negative for hepatitis B surface antigen (HBsAg). Although their exact prevalence is not known, HBV and hepatitis C virus (HCV) infections and occult HBV hepatitis are frequent in maintenance hemodialysis patients. This study aimed to determine the prevalence of occult HBV infection in hemodialysis patients who had chronic HCV infection.
Material and Method: Forty anti HCV and HCV RNA positive, HbsAg negative maintenance hemodialysis patients (19 male, 21 female) were included to this study. Serum samples were tested for HBV DNA by Versant HBV DNA 3.0 assay (Bayer, USA).
Results: Patients were between 33-83 years old with an average age of 55,0 ± 12,4. Average hemodialysis period was 9,8 ± 5,3 years. All patients, except one had normal hepatic enzyme levels. Thirty seven of 40 patients were positive for anti-HBs while two had no detectable serological markers for HBV. Eleven patients had isolated anti-HBs positivity. Total anti-HBc was detected in 26 patients while none of them was isolated positivity. Only one (2,5 %) of the 40 anti-HCV positive, HbsAg negative patients was found positive for HBV-DNA while this patient had also positive anti-HBs and total anti-HBc examinations.
Conclusions: Occult HBV infection is frequent in hemodialysis patients with chronic HCV infection. The clinical significance of this finding is unknown. It should be kept in mind that isolated positive results for anti-HBc, anti-HBc IgM, HbeAg, and anti-HBe may be early predictors of occult HBV infection.
Key Words: Chronic renal failure, Hemodialysis, Hepatitis B virus, Hepatitis C virus, Occult hepatitis B virus infection