Seroprevalence of hepatitis B virus among adults at high risk for HIV transmission two decades after implementation of nationwide hepatitis B virus vaccination program in Taiwan

Abstract

Background: Seroprevalence of hepatitis B virus (HBV) after implementation of universal neonatal HBV vaccination and catch-up vaccination programs remains rarely investigated among the adults who were born in the vaccination era (in or after 1986) and engaged in high-risk sexual behaviors.

Materials and methods: Between 2006 and 2012, we determined HBV surface antigen ([HBsAg), anti-HBs, and HBV core antibody (anti-HBc), hepatitis C virus antibody (anti-HCV) and rapid plasma reagin titers among HIV-infected men who have sex with men (MSM) born during 1984-1985 (Group I: 244 persons) and those born in or after 1986 (Group II: 523), and HIV-uninfected MSM (Group III: 377) and heterosexuals (Group IV: 217) born in or after 1986. Prevalence and incidence of HBV infection were estimated and multivariate analysis was performed to identify factors associated with HBsAg positivity.

Results: Compared with Group I, Groups II-IV had a significantly lower prevalence of HBsAg positivity (7.8% vs 3.7%, 2.4%, and 3.2%, respectively); and the prevalence of anti-HBc positivity was also lower for Groups III and IV (30.3% vs. 19.6%, and 18.0%, respectively), but no difference was observed between Groups I and II (30.3% vs. 26.3%). In multivariate analysis, HBsAg positivity was significantly associated with syphilis (adjusted odds ratio, 2.990; 95% confidence interval, 1.502-5.953) and anti-HCV positivity (adjusted odds ratio, 3.402; 95% confidence interval, 1.091-10.614). In subjects of Group II with all-negative HBV markers at baseline, the incidence rate of HBsAg seroconversion was 0.486 episodes per 100 person-years; and for those who received combination antiretroviral therapy containing lamivudine and/or tenofovir, none developed HBsAg seroconversion during the follow-up.

Conclusions: Among the adults who were born in or after 1986 and engaged in high-risk sexual behaviors in Taiwan, neonatal HBV vaccination and catch-up vaccination programs conferred long-term protection against HBsAg seroconversion and HBsAg positivity was associated with syphilis and anti-HCV positivity.

Figure 1. Comparisons of the proportions of persons with positive HBsAg (HBsAg), all-negative HBV markers (All-negative), vaccination serology (Vaccination), and positive anti-HBc (anti-HBc) among HIV-infected men who have sex with men (MSM) born during 1984–1985 (HIV[+] MSM 1984), HIV-infected MSM born in or after 1986 (HIV[+] MSM 1986), HIV-uninfected MSM and heterosexuals born in or after 1986 (HIV[−] MSM 1986 and (HIV[−] Hetero 1986).

Figure 2. Boxplot of anti-HBs titers in HIV-infected MSM born during 1984-1985 and HIV-infected MSM born in or after 1986.

Figure 3. Comparisons of syphilis (RPR≧4) and anti-HCV positivity among HIV-infected MSM born during 1984–1985 (HIV[+] MSM 1984), HIV-infected MSM born in or after 1986 (HIV[+] MSM 1986), HIV-uninfected MSM and heterosexuals born in or after 1986 (HIV[−] MSM 1986 and (HIV[−] Hetero 1986).