Effective HAART Reduces HBV Risk in Men With HIV

Janis C. Kelly

October 12, 2015

Effective treatment with highly active antiretroviral therapy (HAART) for HIV also protected patients against hepatitis B virus (HBV), according to data on men who have sex with men (MSM). HAART that dropped the viral load of the patient with HIV to less than 400 copies/mL also reduced by 80% the usually elevated HBV risk associated with HIV, returning the HIV-infected patients to the HBV risk level normally seen in patients without HIV.

Oluwaseun Falade-Nwulia, MD, MPH, from Johns Hopkins University, Baltimore, Maryland, and colleagues published their findings online October 13 in the Annals of Internal Medicine.

"What this means to us is that effective HIV therapy appears to restore an impairment in the immune response that protects someone with HIV from acquiring hepatitis B infection," senior author Chloe Thio, MD, professor of medicine at the Johns Hopkins University School of Medicine, said in a university news release.

The researchers also found that a single dose of HBV vaccine was protective, but that only about 60% of the men had been vaccinated.

Data From Two Periods of the Multicenter AIDS Cohort Study

The observational cohort was based on data from 2375 MSM who were not infected with HBV when they enrolled in the Multicenter AIDS Cohort Study, which began in 1984. Median follow-up was slightly less than 10 years.

Because the study involves a prospectively followed cohort of subjects, the researchers were able to use stored specimens and follow-up data to compare incident HBV infection among HIV-infected and HIV-uninfected men before and after the development of HAART. Participants were followed until the date of incident HBV infection, last follow-up visit, or December 31, 2013. Few patients received HAART before 1996, but 65% received HAART by December 1997, so 1996 was considered to mark the end of the "pre-HAART" era.

The authors report that the HBV incidence rate for HIV-infected men treated with HAART who had HIV RNA levels lower than 400 copies/mL was 2.6 per 1000 person-years, which is similar to the rate of 3.1/1000 PYs seen in HIV-uninfected men not receiving HAART and significantly lower than for HIV-infected men treated with HAART but who had higher HIV viral loads. Lamivudine- or emtricitabine-containing HAART regimens and tenofovir disoproxil fumarate-containing HAART regimens were equally protective against HBV.

HBV Vaccination Still Needed in HIV-Infected MSM

Nearly one quarter of all new HBV infections in the United States occur in men who have sex with men. The authors found that even after adjustment for measured risk behaviors, HIV-infected men were twice as likely to acquire HBV infection as HIV-uninfected men. Multivariable analysis showed that age younger than 40 years, two or more sexual partners in the preceding 6 months, and HIV infection were all significant risk factors for HBV infection.

This study also confirmed that even a single dose of HBV vaccine prevented HIV-infected individuals from acquiring a new HBV infection, and that an effective HBV vaccine has been available for 30 years in the United States.

"We found a 70 percent reduction in new HBV infections in the men who reported receiving at least one dose of HBV vaccine," Dr Falade-Nwulia said in the university news release.

Dr Falade-Nwulia also noted that vaccination rates, even in high-risk individuals such as MSM, remain low. When the study began in 1984, only about 31% of men had received at least 1 dose of HBV vaccine, but HBV vaccination rates increased only to about 60% during follow-up. (The Centers for Disease Control and Prevention recommends three doses of the HBV vaccine.)

The authors conclude that effective HAART was associated with reduced rates of incident HBV infection in HIV-infected men but warn that HBV infection rates remain high even among HIV-uninfected MSM or MSM with well-controlled HIV. They note an urgent need for education of both MSM and clinicians about the need for HBV vaccination and about the fact that even HBV-active HAART regimens were not 100% effective in preventing incident HBV in unvaccinated men.

The Multicenter AIDS Cohort Study is funded by the National Institute of Allergy and Infectious Diseases, with additional supplemental funding from the National Cancer Institute. One coauthor reports receiving grants from the National Institutes of Health during the conduct of the study. Another coauthor reports receiving grants from the National Institutes of Health during the conduct of the study and personal fees from Pfizer outside the submitted work. Another coauthor reports receiving grants from the National Institutes of Health during the conduct of the study and grants from Gilead Sciences outside the submitted work. The remaining authors have disclosed no relevant financial relationships.

Ann Intern Med. Published online October 13, 2015. Abstract

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