Epidemiology of Hepatitis B Virus Infection in a US Cohort of HIV‐Infected Individuals during the Past 20 Years

Abstract

Background The epidemiologic trends of hepatitis B virus (HBV) infection in HIV-infected patients over the last twenty years are largely unknown. Methods Prevalence and risk factors for HBV infection overall, at the time of HIV infection, and following HIV infection were examined in an ongoing observational HIV cohort study. Risk factors for HBV infection at the time of HIV diagnosis were evaluated using logistic regression, and risk for incident HBV infection following HIV diagnosis was evaluated using Cox proportional hazards models. Results Of the 2769 evaluable participants, 1078 (39%) had HBV infection, of which 117 (11%) had chronic HBV. The yearly cross-sectional prevalence of HBV infection decreased from a peak of 49% in 1995 to 36% in 2008 (p<0.001). HBV prevalence at the time of HIV diagnosis decreased between 1989 and 2008 from 34% to 9% (p<0.001). The incidence of HBV infection following HIV diagnosis decreased from 4.0/100 person-years in the pre-HAART era to 1.1/100 person-years in the HAART era (p<0.001), but has remained unchanged from 2000 through 2008 (p=0.49), with over 20% of incident HBV infections having chronic HBV. Decreased risk of HBV infection following HIV diagnosis was associated with higher CD4 cell counts and the use of HBV-active HAART. Receipt of ≥1 dose of HBV vaccine was not associated with reduced risk of HBV infection after HIV diagnosis. Conclusions While the burden of HBV infection overall is slowly decreasing among HIV-infected individuals, the persistent rate of HBV infection following HIV diagnosis raises concern that more effective prevention strategies may be needed to significantly reduce HBV infections in this patient population.

Management and treatment of chronic hepatitis B virus infection in HIV positive and negative patients: The EPIB 2008 study

“…In most Western countries, chronic hepatitis B (CHB) is frequently associated with HIV infection, with a 5-to 10-fold greater prevalence compared to the non HIV population, since 5% to 10% of HIV positive patients are chronically infected with HBV [1][2][3][4]. The impact and the perception of HBV-HIV co-infection have evolved over time, from a negligible problem overshadowed by the AIDS related illnesses, towards a genuine risk factor for increased morbidity and mortality [2,5].…”

Incident hepatitis B infection subsequent to the diagnosis of HIV infection in a Melbourne cohort: missed opportunities for prevention

“…One study showed a protective effect of HBVactive HAART, however included only very small numbers of individuals not on an HBV-active regimen. 9 A high proportion (35.9%) of cases had a history of IDU. A higher percentage of cases than controls had IDU exposure.…”

“…15,16 It has been shown that the incidence of chronic HBV infection has decreased since the HAART era. 9 Although we were unable to subdivide our group of patients between before and after the HAART era for analysis due to small numbers; it was evident that several cases of chronic HBV arose in the post-HAART era.…”

“…8 HIV-specific risk factors for incident infection include increasing HIV viral load, prior AIDS-defining illness, and lower current and nadir CD4 counts. 7,9,10 The aim of this study was to determine the risk factors for incident cases of HBV infection occurring after HIV infection in Australia and to demonstrate any missed opportunities for HBV prevention within a Melbourne cohort of HIV-infected individuals.…”

Emerging Challenges in Managing Hepatitis B in HIV Patients

“…However, this rate is more than 100-fold higher than in the general population [5]. In the USA, half of HIV-positive persons have been exposed to HBV, and exhibit markers of spontaneously self-limited HBV infection (HBV core antibodies [anti-HBc] with/without HBV surface antibodies [anti-HBs]) or have serum HBsAg+ [9].…”