Few HIV-positive Americans vaccinated against HBV and 7% coinfected with HIV/HBV

Michael Carter
Estimated reading time 3 minutes
This article is more than 21 years old.

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.

Glossary

multivariate analysis

An extension of multivariable analysis that is used to model two or more outcomes at the same time.

acute infection

The very first few weeks of infection, until the body has created antibodies against the infection. During acute HIV infection, HIV is highly infectious because the virus is multiplying at a very rapid rate. The symptoms of acute HIV infection can include fever, rash, chills, headache, fatigue, nausea, diarrhoea, sore throat, night sweats, appetite loss, mouth ulcers, swollen lymph nodes, muscle and joint aches – all of them symptoms of an acute inflammation (immune reaction).

retrospective study

A type of longitudinal study in which information is collected on what has previously happened to people - for example, by reviewing their medical notes or by interviewing them about past events. 

hepatitis B virus (HBV)

The hepatitis B virus can be spread through sexual contact, sharing of contaminated needles and syringes, needlestick injuries and during childbirth. Hepatitis B infection may be either short-lived and rapidly cleared in less than six months by the immune system (acute infection) or lifelong (chronic). The infection can lead to serious illnesses such as cirrhosis and liver cancer. A vaccine is available to prevent the infection.

AIDS defining condition

Any HIV-related illness included in the list of diagnostic criteria for AIDS, which in the presence of HIV infection result in an AIDS diagnosis. They include opportunistic infections and cancers that are life-threatening in a person with HIV.

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)

References

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.

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