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发表于 2005-2-1 10:19
| OCCULT HBV INFECTION
Occult HBV in hemodialysis patients. HBV infection continues to occur in adult hemodialysis patients, and a possible contributing factor is the presence of occult HBV infection (negative HBsAg, but positive HBV DNA). To document the prevalence of HBV infection in this population, Gerald Minuk and others screened 241 adult hemodialysis patients for occult HBV utilizing real-time PCR with 2 independent primer sets (core promoter and surface). Two patients (0.8%) were HBsAg(+). Among the remaining 239 HBsAg(-) patients, 9 patients (3.8%) had detectable levels of HBV DNA in the serum with viral loads ranging from102 to 104 viral copies/mL. Seven of these 9 patients were nt 587 mutation (S-mutant) positive. No demographic factors were found to be predictive for occult HBV infection. These findings indicate the prevalence of occult HBV is 4-5 times higher than HBsAg testing would suggest and these infections are frequently associated with low viral loads and the S-mutant. A monoclonal based EIA was used for detection of HBsAg, which may have accounted for the failure to detect the S-mutant. Of the 228 individuals with information available regarding HBV vaccination status, only 202 (88.6%) had completed the course of vaccination, which may have contributed to the high rate of HBV infection. Additional studies are needed to further evaluate the clinical relevance of detection of HBV DNA with sensitive PCR-based assays, and whether or not screening dialysis patients and staff with these assays should be performed. (Minuk GY, et al. Hepatology 2004;40:1072-1077) |
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