Incident hepatitis B infection subsequent to the diagnosis of HIV infection in a Melbourne cohort: missed opportunities for prevention
Amy Body A , Jennifer F. Hoy A B , Allen C. Cheng B C and Michelle L. Giles A B DA Infectious Diseases Unit, Alfred Hospital, Melbourne, Vic. 3004, Australia.
B Department of Infectious Diseases, Monash University, Melbourne, Vic. 3004, Australia.
C Department of Epidemiology and Preventive Medicine, Monash University and Alfred Hospital, Melbourne, Vic. 3004, Australia.
D Corresponding author. Email: michelle.giles@monash.edu
Sexual Health 11(1) 5-10 https://doi.org/10.1071/SH13019
Submitted: 4 February 2013 Accepted: 22 July 2013 Published: 25 October 2013
Abstract
Background: The characteristics associated with incident hepatitis B (HBV) infection in HIV-positive individuals are not well described in the Australian setting. The aim of this study is to determine the characteristics of and risk factors for HBV infection within HIV-infected individuals in a Melbourne cohort between 1985 and 2011. Methods: Individuals susceptible to HBV at their HIV diagnosis were identified using their HBV serology stored within the Victorian HIV database. Within this group, those who had a subsequent positive test for hepatitis B surface antigen or hepatitis B core antibody were identified as infected with HBV after their HIV diagnosis. Incident cases were matched with controls from the initially susceptible group who did not seroconvert for analysis. An incidence rate was calculated from the number of seroconversions and the cumulative time at risk (in 1000 patient-years of follow-up). Results: Of the 4711 patients with HIV seen more than once, 3223 had HBV testing. Of the 174 with positive HBV test results, 39 individuals met the definition of seroconversion after HIV diagnosis, representing the incident cases. The estimated HBV incidence rate was 1.81 (95% confidence interval: 1.28–2.47) per 1000 patient-years at risk. These individuals form the basis of a detailed case series and case–control study. Data collected include demographic details, immunological and virological characteristics, antiretroviral treatment and vaccination history. Conclusions: HIV-infected individuals should be screened for HBV and monitored for incident infection. Optimal control of HIV and improved vaccination coverage provide the best opportunity for prevention.
Additional keywords: coinfection, incidence, serology, susceptibility.
References
[1] Thio CL, Seaberg EC, Skolasky R, Phair J, Visscher B, Munoz A, et al HIV-1, hepatitis B virus, and risk of liver-related mortality in the Multicenter Cohort Study (MACS). Lancet 2002; 360 1921–6.| HIV-1, hepatitis B virus, and risk of liver-related mortality in the Multicenter Cohort Study (MACS).Crossref | GoogleScholarGoogle Scholar | 12493258PubMed |
[2] Fonseca MO, Pang LW. Cavalheiro NdP, Barone AA, Lopes MH. Randomized trial of recombinant hepatitis B vaccine in HIV-infected adult patients comparing a standard dose to a double dose. Vaccine 2005; 23 2902–8.
| Cavalheiro NdP, Barone AA, Lopes MH. Randomized trial of recombinant hepatitis B vaccine in HIV-infected adult patients comparing a standard dose to a double dose.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD2MXisVWktL4%3D&md5=880031fb027104f45931eb5bbc64c0aaCAS | 15780739PubMed |
[3] Launay O, van der Vliet D, Rosenberg AR, Michel M-L, Piroth L, Rey D, et al Safety and immunogenicity of 4 intramuscular double doses and 4 intradermal low doses vs standard hepatitis B vaccine regimen in adults with HIV-1: a randomized controlled trial. JAMA 2011; 305 1432–40.
| Safety and immunogenicity of 4 intramuscular double doses and 4 intradermal low doses vs standard hepatitis B vaccine regimen in adults with HIV-1: a randomized controlled trial.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC3MXkvFWls7k%3D&md5=f4ef8ea09f32501ddc231a5876ea1d2cCAS | 21486976PubMed |
[4] Bailey CL, Smith V, Sands M. Hepatitis B vaccine: a seven-year study of adherence to the immunization guidelines and efficacy in HIV-1-positive adults. Int J Infect Dis 2008; 12 e77–83.
| Hepatitis B vaccine: a seven-year study of adherence to the immunization guidelines and efficacy in HIV-1-positive adults.Crossref | GoogleScholarGoogle Scholar | 18723381PubMed |
[5] Spradling PR, Richardson JT, Buchacz K, Moorman AC, Brooks JT, HIV Outpatient Study (HOPS) Investigators Prevalence of chronic hepatitis B virus infection among patients in the HIV Outpatient Study, 1996–2007†. J Viral Hepat 2010; 17 879–86.
| Prevalence of chronic hepatitis B virus infection among patients in the HIV Outpatient Study, 1996–2007†.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC3cbpsFylsg%3D%3D&md5=97d70a90016e26d0f58c8aaca51f44d3CAS | 20158604PubMed |
[6] Custer B, Sullivan SD, Hazlet TK, Iloeje U, Veenstra DL, Kowdley KV. Global epidemiology of hepatitis B virus. J Clin Gastroenterol 2004; 38 S158–68.
| Global epidemiology of hepatitis B virus.Crossref | GoogleScholarGoogle Scholar | 15602165PubMed |
[7] Konopnicki D, Mocroft A, De Wit S, Antunes F, Ledergerber B, Katlama C, et al Hepatitis B and HIV: prevalence, AIDS progression, response to highly active antiretroviral therapy and increased mortality in the EuroSIDA cohort. AIDS 2005; 19 593–601.
| Hepatitis B and HIV: prevalence, AIDS progression, response to highly active antiretroviral therapy and increased mortality in the EuroSIDA cohort.Crossref | GoogleScholarGoogle Scholar | 15802978PubMed |
[8] Zhou J, Dore G, Zhang F, Lim P, Chen Y, TREAT Asia HIV Observational Database Hepatitis B and C virus coinfection in The TREAT Asia HIV Observational Database. Journal of Gastroenterology and Hepatology 2007; 22 1510–8.
| 17645479PubMed |
[9] Chun HM, Fieberg AM, Hullsiek KH, Lifson AR, Crum-Cianflone NF, Weintrob AC, et al Epidemiology of hepatitis B virus infection in a US cohort of HIV-infected individuals during the past 20 years. Clin Infect Dis 2010; 50 426–36.
| Epidemiology of hepatitis B virus infection in a US cohort of HIV-infected individuals during the past 20 years.Crossref | GoogleScholarGoogle Scholar | 20047484PubMed |
[10] Tedaldi E, Peters L, Neuhaus J, Puoti M, Rockstroh J, Klein MB, et al Opportunistic disease and mortality in patients coinfected with hepatitis B or C virus in the Strategic Management of Antiretroviral Therapy (SMART) Study. Clinical Infectious Diseases 2008; 47 1468–75.
| 18959492PubMed |
[11] Landrum ML, Hullsiek KH, Ganesan A, Weintrob AC, Crum-Cianflone NF, Barthel RV, et al Hepatitis B vaccination and risk of hepatitis B infection in HIV-infected individuals. AIDS 2010; 24 545–55.
| Hepatitis B vaccination and risk of hepatitis B infection in HIV-infected individuals.Crossref | GoogleScholarGoogle Scholar | 19487908PubMed |
[12] Dentico P, Buongiorno R, Volpe A, Zavoianni A, Pastore G, Schiraldi O. Long-term immunogenicity safety and efficacy of a recombinant hepatitis B vaccine in healthy adults. Eur J Epidemiol 1992; 8 650–5.
| Long-term immunogenicity safety and efficacy of a recombinant hepatitis B vaccine in healthy adults.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK3s%2FltVSktg%3D%3D&md5=a1a0a6b34d959ab5cb257c1de787a390CAS | 1426164PubMed |
[13] Kellerman SE, Hanson DL, McNaghten AD, Fleming PL. Prevalence of chronic hepatitis B and incidence of acute hepatitis B infection in human immunodeficiency virus-infected subjects. J Infect Dis 2003; 188 571–7.
| Prevalence of chronic hepatitis B and incidence of acute hepatitis B infection in human immunodeficiency virus-infected subjects.Crossref | GoogleScholarGoogle Scholar | 12898445PubMed |
[14] McMahon BJ, Alward WLM, Hall DB, Heyward WL, Bender TR, Francis DP, et al Acute hepatitis B virus infection: relation of age to the clinical expression of disease and subsequent development of the carrier state. J Infect Dis 1985; 151 599–603.
| Acute hepatitis B virus infection: relation of age to the clinical expression of disease and subsequent development of the carrier state.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaL2M7jt12hsg%3D%3D&md5=367925707bd4fea76fd62fe05b622f7bCAS | 3973412PubMed |
[15] Landrum ML, Fieberg AM, Chun HM, Crum-Cianflone NF, Marconi VC, et al The effect of human immunodeficiency virus on hepatitis B virus serologic status in co-infected adults. PLoS ONE 2010; 5 e8687
| The effect of human immunodeficiency virus on hepatitis B virus serologic status in co-infected adults.Crossref | GoogleScholarGoogle Scholar | 20084275PubMed |
[16] Hadler SC, Judson FN, O’Malley PM, Altman NL, Penley K, Buchbinder S, et al Outcome of hepatitis B virus infection in homosexual men and its relation to prior human immunodeficiency virus infection. J Infect Dis 1991; 163 454–7.
| Outcome of hepatitis B virus infection in homosexual men and its relation to prior human immunodeficiency virus infection.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK3M7ktVSjtA%3D%3D&md5=fcd5b8c04a6a193bfe3a52de9c7a76aaCAS | 1825315PubMed |
