Between 1986 and 2006, participants in the Tri-Service
AIDS Clinical Consortium (TACC) HIV Natural History Study were assessed for HBV
prevalence and risk factors at the time of HIV diagnosis (baseline), as well as
the incidence and risk factors for HBV infection after HIV diagnosis.
For
patients with a known HIV seroconversion window of 3 years or less, the risk of
HBV infection at baseline was assessed using 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.
Results
•
Among 1648 study participants with a known
seroconversion window, 457 (28%) were HBV positive at baseline, of whom 37 (8%)
had chronic hepatitis B.
•
Overall, the risk of HBV infection at baseline
among HIV seroconverters was associated with older age (OR 2.0), male sex (OR
6.3), and prior receipt of HBV vaccination (OR 0.4).
•
During the HAART era, HBV infection was also
associated with a history of sexually transmitted infections (OR 1.5).
•
Among the 2137 participants who were HBV negative
at baseline, 431 (20%) subsequently were infected with HBV, of whom 47 (11%) developed
chronic hepatitis B.
•
Risk factors for incident HBV infection were
male sex (HR 6.7), African-American race/ethnicity (HR 1.4 compared with Caucasians),
and prior sexually transmitted infections (HR 1.3).
•
Protective factors against incident HBV infection
included the use of HAART (HR 0.5) and prior receipt of HBV vaccination (HR 0.7).
Conclusion
"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,"
the researchers concluded.
"While HAART reduced the risk of HBV after
diagnosis of HIV, the total burden of HBV-HIV coinfection remains large, due,
in part, to high-risk sexual behavior both prior to and after HIV diagnosis in
the HAART era," they continued.
Finally, they recommended, "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 coinfection."
Naval
Hlth Res Ctr, San Diego, CA; Naval Med Ctr San Diego, CA; Univ of Minnesota, Minneapolis,
MN; Infectious Disease Clinical Res Prgm, Bethesda, MD; Natl Naval Med Ctr, Bethesda,
MD; Walter Reed Army Med Ctr, Washington, DC; Naval Med Ctr Portsmouth, VA; San
Antonio Med Ctr, Fort Sam Houston, TX.
2/5/08
Reference H
Chun, A Fieberg, K Huppler Hullsiek, and others. The Epidemiology of Hepatitis
B Virus Infection in HIV-1-infected Individuals over 20 Years: The Effect of HAART
and Vaccination. CROI 2008. Boston, MA. February 3-6, 2008. Abstract 1028.
Effect
of HAART and Hepatitis B Vaccination on Epidemiology of HIV-HBV Coinfection
Due
to similar routes of transmission, many 
