1028
The Epidemiology of Hepatitis B Virus Infection in HIV-1-infected Individuals over 20 Years: The Effect of HAART and Vaccination
H Chun1,2, A Fieberg3,4, K Huppler Hullsiek3,4, N Crum-Cianflone2,4, W Bradley4, A Ganesan4,5, A Weintrob4,6, Robert Barthel*7, and M Landrum4,8
1Naval Hlth Res Ctr, San Diego, CA, US; 2Naval Med Ctr San Diego, CA, US; 3Univ of Minnesota, Minneapolis, US; 4Infectious Disease Clinical Res Prgm, Bethesda, MD, US; 5Natl Naval Med Ctr, Bethesda, MD, US; 6Walter Reed Army Med Ctr, Washington, DC, US; 7Naval Med Ctr Portsmouth, VA, US; and 8San Antonio Med Ctr, Fort Sam Houston, TX, US
Background: Prevention efforts against hepatitis B
virus (HBV) infection may be improved by better quantifying the risk of HBV
infection in relation to the timing of HIV infection. We describe the
prevalence and risk factors for HBV infection prior to and following HIV
infection among participants in the Tri-Service AIDS Clinical Consortium (TACC)
HIV Natural History Study (NHS).
Methods: Between 1986 and 2006, subjects enrolled in
the TACC NHS were examined for the prevalence and risk factors for HBV at the
time of HIV diagnosis (baseline), and the incidence and risk factors for HBV
infection after HIV diagnosis. For those with a known HIV seroconversion window
of 3 years or less, the risk for HBV at baseline was assessed with multivariate
logistic regression for 3 periods: pre-HAART, post-HAART, and overall. Risk
factors for incident HBV after baseline were determined using multivariate Cox
regression. Odds ratios (OR) and hazard ratios (HR) are given with 95%
confidence intervals.
Results: Among 1648 with a known seroconversion
window, 457 (28%) were HBV positive at baseline, 37 (8%) of whom had chronic HBV.
Overall, the risk of HBV at baseline among seroconversion was associated with
older age (OR 2.0; 1.7 to 2.4), male gender (OR 6.3; 2.5 to 16.0), and prior
receipt of HBV vaccine (OR 0.4; 0.3 to 0.6). During the HAART era, HBV infection
was also associated with a history of a previous sexually transmitted infection
(OR 1.5; 1.0 to 2.2). Among the 2137 who were HBV negative at baseline, 431
(20%) subsequently developed hepatitis B, 47 (11%) of whom resulted in chronic
hepatitis. Risk factors for incident HBV were male gender (HR 6.7; 3.2 to 14.2),
African American ethnicity (HR 1.4; 1.1 to 1.7 compared to Caucasians), and
prior sexually transmitted infection (HR 1.3; 1.0 to 1.5). Protective factors
against incident HBV included the use of HAART (HR 0.5; 0.3 to 0.9) and prior
receipt of HBV vaccine (HR 0.7; 0.5 to 0.9).
Conclusions: In addition to a high prevalence of HBV
observed at the time of HIV diagnosis, HBV seronegative individuals remain at
high risk for HBV following HIV diagnosis. While HAART reduced the risk of HBV after
diagnosis of HIV, the total burden of HB/HIV co-infection remains large, due,
in part, to high-risk sexual behavior both prior to and after HIV diagnosis in
the HAART era. Vaccination targeted at all high-risk individuals both prior to
and after HIV infection should be the cornerstone of prevention efforts to
reduce the burden of HBV/HIV co-infection.
|
