Only a small minority of HIV-positive Americans have been vaccinated against hepatitis B virus, and over 7% are coinfected with the liver disease, according to data from the US Center for Disease Control’s Adult/Adolescent Spectrum of HIV Disease Project (ASD), published in the August 15th edition of the Journal of Infectious Diseases.
Since the introduction of HAART, liver disease caused by hepatitis B and hepatitis C has emerged as a significant cause of illness and death in HIV-positive patients. Accordingly, the ASD investigators wished to establish the incidence of new hepatitis B infections amongst HIV-positive patients; the prevalence of chronic hepatitis B; the number of patients who had been vaccinated against hepatitis B; and the effect of anti-HIV therapy (particularly 3TC) on the incidence and prevalence of hepatitis B coinfection. The ASD study ran between summer 1998 and summer 2001. HIV-positive individuals aged over 13 years were eligible for inclusion and were recruited from 100 HIV-treatment centres in eleven US cities.
A total of 316 acute cases of hepatitis B were detected by the investigators from a retrospective chart review, providing an incidence of 12.2 cases per 100 patient years. Only 14% of patients had been vaccinated against hepatitis B, and multivariate analysis showed that unvaccinated individuals contracting hepatitis B were more likely to be black or hispanic, and have a history of injecting drug use and alcohol abuse. A previous AIDS defining illness was also predictive of acute hepatitis B.
A total of 19,905 individuals were eligible for analysis for the presence of chronic hepatitis B infection. A total of 1,506 cases were recorded with a prevalence of 7.6%. The prevalence of chronic hepatitis B was highest amongst gay men who injected drugs (11.7%), followed by gay men (9.2%), and injecting drug users (7.1%). Individuals who had received anti-HIV therapy including 3TC, which is active against both HIV and hepatitis B, had a prevalence of hepatitis B coinfection of 2.3%. Amongst patients who had received antiretroviral therapy without 3TC, 7.8% had chronic hepatitis B, and 22.1% of individuals who had never received anti-HIV drugs had established hepatitis B infection.
On the basis of these findings, the ASD investigators estimate that there are between 5,100 and 5,700 HIV-positive people are newly infected every year with hepatitis B in the USA, and that between 55,600 – 62,100 HIV-positive individuals have chronic hepatitis B infection.
Despite changes in sexual practices and the availability of an effective hepatitis B vaccine, the investigators conclude on the basis of these data that HIV-positive individuals remain at high risk of hepatitis B, and they call for hepatitis B prevention strategies to be incorporated in routine HIV care.
Further information on this website
Hepatitis B - overview
Hepatitis B - factsheet
HIV and hepatitis - booklet in the information for HIV-positive people series (pdf)
Kellerman SE et al. Prevalence of chronic hepatitis B and incidence of acute hepatitis B infection in human immunodeficiency virus-infected subjects. Journal of Infectious Diseases 188: 571 – 77, 2003.