1036
Long-term Serologic Follow-up of HIV-infected Women with Isolated Hepatitis B Core Antibody: Predictors of Acquisition of Hepatitis B Surface Antibody
Michael Lin*1,2, C Evans3, E Operskalski4, M Augenbraun5, A Howard6, M Young7, L Benning8, M Peters9, A French1,2, and Women's Interagency HIV Study (WIHS)
1Rush Univ Med Ctr, Chicago, IL, US; 2CORE Ctr and Storger Hosp, Chicago, IL, US; 3Univ of Illinois at Chicago, US; 4Univ of Southern California, Los Angeles, US; 5State Univ of NewYork Downstate Med Ctr, Brooklyn, US; 6Montefiore Med Ctr, Bronx, NY, US; 7Georgetown Univ Med Ctr, Washington, DC, US; 8Johns Hopkins Univ Bloomberg Sch of Publ Hlth, Baltimore, MD, US; and 9Univ of California, San Francisco, US
Background: Hepatitis B core antibody (anti-HBc) in
the absence of hepatitis B surface antigen (HBsAg) and hepatitis B surface
antibody (anti-HBs) is common among HIV-infected persons but the clinical
significance and outcome are unclear. To determine the long-term serologic
outcome of isolated anti-HBc in HIV infection, we studied women participating
in the Women's Interagency HIV Study (WIHS); 15% of WIHS women had isolated
anti-HBc at baseline and only 2% of these were explained by occult hepatitis B
(HBV) viremia.
Methods: WIHS is a multi-site prospective
observational study in which semiannual interview and laboratory data are
collected. We studied 285 HIV-infected women with isolated anti-HBc at study
entry. Follow-up hepatitis B serologies were measured on banked serum at a
single time point from baseline. Univariate and multivariate logistic
regression analyses were performed to find predictors of conversion to positive
anti-HBs.
Results: Mean follow-up time was 7.5 years (range,
2.5 to 10.4). At follow-up, 58 of 285 patients (20.4%) were positive for
anti-HBs, 202 patients (70.8%) remained positive for anti-HBc only, 7 (2.5%)
had acquired detectable HBsAg, and 18 (6.3%) had no positive HBV serology.
Predictors of conversion to anti-HBs in univariate analysis were antiretroviral
therapy (odds ratio [OR] 2.21 (95% confidence interval 1.23 to 3.96) and
increase in CD4 count between baseline and follow-up (OR 1.14; 1.04 to 1.27),
while older age, illicit drug use, hepatitis C (HCV) RNA positivity and CD4
<200 cells/cm3 at follow-up were negatively associated (all p <0.05);
47 women reported incident HBV vaccination (of whom 13 converted to anti-HBs),
which was not significantly associated with conversion. Also not associated
with conversion were duration of follow-up, race, sexual risk, HIV viral load
and use of ART active against HBV. In multivariate analysis, an increase in CD4
count (OR 1.14; 1.03 to 1.26) was a positive predictor of conversion to
anti-HBs and active HCV (OR 0.23; 0.12 to 0.45) was negatively associated.
Re-analysis excluding women reporting incident HBV vaccination produced similar
results.
Conclusions: In a cohort of HIV-infected women with
isolated anti-HBc followed for a mean of 7.5 years, the majority remained
isolated anti-HBc positive. Conversion to anti-HBs was associated positively
with increase in CD4 count and negatively with active HCV. Whether these
factors are more important than HBV vaccination in predicting conversion to
anti-HBs needs further study.
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