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

Abstract

Abstract. Background:The characteristics associated with incident hepatitis B (HBV) infection in HIV-positive individuals are not well described in the Australian setting. The aim of this study is to determine the characteristics of and risk factors for HBV infection within HIV-infected individuals in a Melbourne cohort between 1985 and 2011. Methods: Individuals susceptible to HBV at their HIV diagnosis were identified using their HBV serology stored within the Victorian HIV database. Within this group, those who had a subsequent positive test for hepatitis B surface antigen or hepatitis B core antibody were identified as infected with HBV after their HIV diagnosis. Incident cases were matched with controls from the initially susceptible group who did not seroconvert for analysis. An incidence rate was calculated from the number of seroconversions and the cumulative time at risk (in 1000 patient-years of follow-up). Results: Of the 4711 patients with HIV seen more than once, 3223 had HBV testing. Of the 174 with positive HBV test results, 39 individuals met the definition of seroconversion after HIV diagnosis, representing the incident cases. The estimated HBV incidence rate was 1.81 (95% confidence interval: 1.28-2.47) per 1000 patient-years at risk. These individuals form the basis of a detailed case series and case-control study. Data collected include demographic details, immunological and virological characteristics, antiretroviral treatment and vaccination history. Conclusions: HIV-infected individuals should be screened for HBV and monitored for incident infection. Optimal control of HIV and improved vaccination coverage provide the best opportunity for prevention.

Hepatitis B in men who have sex with men and HIV-infected individuals: missed opportunities and future challenges

“…Both of these recent studies highlighted missed opportunities for screening, vaccination and follow-up testing to ensure the protection of individuals at particular risk of HBV infection. 3,4 This new evidence reinforces the need for a greater focus on comprehensive testing and vaccination of priority populations, including HIV-infected individuals and MSMparticularly given recent reports of increasing sexual risk practices in MSM and corresponding increases in sexually transmissible infections, including HIV. 7 With an estimated 218,00 people (1.0% of the population) living with chronic hepatitis B (CHB) in 2011, 8 Australia is generally a low-prevalence country, with the main burden of disease experienced by those born overseas in endemic areas, and by Aboriginal and Torres Strait Islander people.…”

“…3 These results indicate missed opportunities for prevention through vaccination, and suggest infrequent routine testing to determine anti-HBs status and promote vaccination. Together, they suggest that the prevention of HBV infection in HIVinfected individuals needs greater attention.…”

“…3,4 Although this is a common definition, this serological pattern can also be observed in those previously successfully vaccinated who still retain memory immunity and who demonstrate an anamnestic response on rechallenge by either the vaccine or by HBV infection. 22,23 This is why no booster vaccination is recommended in immunocompetent individuals who have completed a full course of vaccination (particularly if previously documented to have a protective antiHBs titre).…”

“…1,2 In this edition of Sexual Health, Body et al 3 report an incidence of 1.8 hepatitis B virus (HBV) infections per 1000 person years in the Victorian HIV database (VHIVSD), a cohort of HIV-infected individuals receiving care at a tertiary referral hospital in Melbourne. A similar incidence of infection (1.98 per 1000 person-years) was found by Gamagedara et al among men who have sex with men (MSM) attending a community sexual health centre, also in Melbourne.…”

“…Similarly, Body et al report that HBsAg and anti-HBc testing were not performed in 32% of HIV-positive individuals. 3 The National Hepatitis B Testing Policy released in 2012 recommends testing for all three markers of HBV infection in those at higher risk of CHB, including MSM and HIVinfected individuals. 13 The use of alternative screening algorithms can lead to missing chronic infections, and creates the need for unnecessary vaccination, recall and repeat testing of individual patients.…”