High Prevalence and High Incidence of Coinfection with Hepatitis B, Hepatitis C, and Syphilis and Low Rate of Effective Vaccination against Hepatitis B in HIV-Positive Men Who Have Sex with Men with Known Date of HIV Seroconversion in Germany

Abstract

Objectives: Men who have sex with men (MSM) are at higher risk for coinfection with hepatitis B virus (HBV), hepatitis C virus (HCV), and syphilis than the general population. HIV infection and these coinfections accelerate disease progression reciprocally. This study evaluated the prevalence and incidence of these coinfections in HIV1-positive MSM in Germany.

Materials and methods: As part of a nationwide, multicenter, prospective cohort study of HIV-infected MSM, plasma samples collected yearly were screened for HBsAg and antibodies to HBc, HBs, HCV, and syphilis. Samples with indications of active HBV or HCV infection were confirmed by polymerase chain reaction. Prevalence and incidence of each infection and incidence rates per study participant were calculated, and incidences over 4-year time intervals compared.

Results: This study screened 5,445 samples from 1,843 MSM. Median age at HIV seroconversion was 33 years. Prevalences of active, cleared, and occult HBV, and of active/cleared HCV were 1.7%, 27.1%, 0.2%, and 8.2%, respectively, and 47.5% had been effectively vaccinated against HBV. Prevalence of antibodies to Treponema pallidum and of triple or quadruple sexually transmitted infections (STIs) were 39.6% and 18.9%, respectively. Prevalence of STI, cleared HBV, HBV vaccination, and history of syphilis differed significantly among age groups. Incidences of HBV, HCV, and syphilis were 2.51, 1.54, and 4.06 per 100 person-years, respectively. Incidences of HCV and syphilis increased over time. HCV incidence was significantly higher in MSM coinfected with syphilis and living in Berlin, and syphilis incidence was significantly higher for MSM living in Berlin.

Discussion: Despite extensive HBV vaccination campaigns, fewer than 50% of screened MSM were effectively vaccinated, with a high proportion of HIV-positive MSM coinfected with HBV. High rates of STI coinfections in HIV-positive MSM and increasing incidences emphasize the need for better tailored campaigns for HBV vaccination and STI prevention.

Fig 1. Prevalences of coinfections in MSM of the HIV seroconverter cohort.

The figure shows coinfections with hepatitis B virus (HBV), hepatitis C virus (HCV), and syphilis. The areas of the ellipses correspond to the calculated proportions of the respective coinfections. White numbers: proportions of respective multiple infections. All percentages are relative to the total number of HIV-positive MSM (N = 1,838). The category “HBV” comprises HIV-positive MSM testing positive for an active, cleared, or occult HBV coinfection; the category “HCV” comprises HIV-positive MSM testing positive for an acute/chronic or cleared HCV-coinfection (for a definition on the basis of the serological testing results of these categories, see Table 1).

Fig 2. Incidences of coinfections in MSM of the HIV seroconverter cohort, by time period.

Incidences of hepatitis B virus (HBV), hepatitis C virus (HCV), and syphilis infection were calculated per 100 person-years (PY). Whisker graphs show lower and upper limits of calculated 95% confidence intervals. Time under follow-up (number of PY) per infection and time period are indicated below the figure.

Fig 3. Incidence rate ratios (IRR) of coinfections in MSM of the HIV seroconverter cohort.

IRR for infection with hepatitis B virus (HBV), hepatitis C virus (HCV), and syphilis were calculated for persons living in Berlin and those living elsewhere in Germany and in persons testing positive for syphilis at any time point or and those always testing negative. Whisker graphs show lower and upper limits of calculated 95% confidence intervals.