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 human immunodeficiency virus (HIV)-infected patients over the past 20 years are largely unknown.

Methods: Prevalence and risk factors for HBV infection overall, at the time of HIV infection, and after HIV infection were examined in an ongoing observational HIV cohort study. Risk factors for HBV infection at the time of diagnosis of HIV infection were evaluated using logistic regression, and risk of incident HBV infection after diagnosis of HIV infection was evaluated using Cox proportional hazards models.

Results: Of the 2769 evaluable participants, 1078 (39%) had HBV infection, of whom 117 (11%) had chronic HBV infection. The yearly cross-sectional prevalence of HBV infection decreased from a peak of 49% in 1995 to 36% in 2008 (P < .001). The prevalence of HBV infection at the time of diagnosis of HIV infection decreased during 1989-2008 from 34% to 9% (P < .001). The incidence of HBV infection after diagnosis of HIV infection decreased from 4.0 cases per 100 person-years during the pre-highly active antiretroviral therapy (HAART) era to 1.1 cases per 100 person-years during the HAART era (P < .001); however, this incidence remained unchanged during 2000-2008 (P = .49), with >20% of HBV infections occurring after HIV infection being chronic. Decreased risk of HBV infection after diagnosis of HIV infection was associated with higher CD4 cell count and the use of HBV-active HAART. Receipt of 1 dose of HBV vaccine was not associated with reduced risk of HBV infection after diagnosis of HIV infection.

Conclusions: Although the burden of HBV infection overall is slowly decreasing among HIV-infected individuals, the persistent rate of HBV infection after diagnosis of HIV infection raises concern that more-effective prevention strategies may be needed to significantly reduce the prevalence of HBV infection in this patient population.

Figure 1

Flow diagram of participant selection for three analysis groups (see Methods). HBV, hepatitis B virus, NHS, Natural History Study, HIV, human immunodeficiency virus

Figure 2

Cross-sectional prevalence of HBV and chronic HBV infection by calendar year for participants with serological HBV assessment (N=2769). (p<0.001 for trend for both HBV and chronic HBV prevalence). The solid and dotted lines represent the local linear robust fit smoothing line and the pointwise 95% confidence intervals respectively for the prevalence at the time of HBV diagnosis of both HBV and chronic HBV. Participants could contribute to every year for which they were seen and evaluated. HBV, hepatitis B virus, HAART, highly active antiretroviral therapy.

Figure 3

Prevalence of HBV and chronic HBV at the time of HIV diagnosis by year among participants with known recent HIV infection (defined as documented HIV seroconversion within the preceding three years) and HBV serological assessment within 6 months of HIV diagnosis (N=1885). (for HBV, p<0.001 for trend; for chronic HBV, p=0.002 for trend) The solid and dotted lines represent the local linear robust fit smoothing line and the pointwise 95% confidence intervals respectively for the prevalence at the time of HBV diagnosis of both HBV and chronic HBV. Participants could only contribute to the year in which they were diagnosed with HIV. HBV, hepatitis B virus, HAART, highly active antiretroviral therapy.

Figure 4

Incidence of HBV infection after HIV diagnosis for HIV-seroprevalent participants who were HBV sero-negative at the time of HIV diagnosis (N=1872). (For comparing the rate of HBV in the pre-HAART era to the HAART era, p<0.001. The rate of chronic HBV in the pre-HAART era was 1.2 per 100 PY (95% CI 0.7–1.6) compared to 0.12 per 100 PY (95% CI 0.03–0.19) for the HAART era (p<0.001). The solid and dotted lines represent the local linear robust fit smoothing line and the pointwise 95% confidence intervals respectively for the incidence of both HBV and chronic HBV. Participants could contribute to every year for which they were seen and evaluated until last study visit or the occurrence of HBV infection. HBV, hepatitis B virus, HAART, highly active antiretroviral therapy.