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Prevalence, Patterns, and Course of Past Hepatitis B Virus Infection in Intravenous Drug Users With Hiv-1 Infection

Rodríguez-Méndez, M L, MD1; González-Quintela, A, MD1; Aguilera, A, MD2; Barrio, E, MD1

American Journal of Gastroenterology: May 2000 - Volume 95 - Issue 5 - p 1316–1322
doi: 10.1111/j.1572-0241.2000.01981.x

OBJECTIVE: Hepatitis B virus (HBV) and human immunodeficiency virus (HIV) share common routes of transmission. Therefore, markers of either active or past HBV infection are present in many HIV-infected patients, particularly in intravenous drug users (IDUs). The aim of this study was to analyze the serological pattern of past HBV infection (presence or absence of anti-HBs) and the course of past HBV infection (changes in anti-HBs status, and HBV reactivation) in two cohorts of IDUs with and without HIV infection.

METHODS: HBV serum markers were studied in 388 HIV-positive and 197 HIV-negative IDUs. Among them, 263 HIV-positive and 50 HIV-negative patients with past HBV infection (serum HBsAg negative and anti-HBc positive, with or without anti-HBs) were followed-up for a median of 21 and 13 months, respectively, to detect changes in anti-HBs status and HBV reactivation.

RESULTS: The prevalence of HBV infection (either active or past) was higher in HIV-positive than in HIV-negative cases (90% vs 62%, p < 0.001), even when stratified by years of drug use. Most cases (92% of HIV-positive and 89% of HIV-negative) had markers of past infection. Among those patients with past HBV infection, 60% of HIV-positive and 72% of HIV-negative presented serum anti-HBs (p = 0.03). The incidence of anti-HBs loss was 1.8 cases/100 person-year in HIV-positive, and 1.8 cases/100 person-year in HIV-negative patients (RR 1.0, 95% CI 0.1–94, p = NS). Incidence of anti-HBs development was 17.6 cases/100 person-year in HIV-positive and 25.6 cases/100 person-year in HIV-negative IDUs (RR, 1.5, 95% CI, 0.6–3.5, p = NS). Only one HIV-positive patient with markers of past HBV infection developed an active infection (0.2 events/100 person-year).

CONCLUSIONS: HBV infection (either active or past) is particularly frequent in HIV-positive IDUs. Most cases have markers of past infection. Isolated detection of anti-HBc (absence of anti-HBs) is more common in HIV-positive than in HIV-negative IDUs. Despite their progressive immunosuppression, both anti-HBs loss and HBV reactivation are rare in HIV-infected IDUs.

1Departments of Internal Medicine, Complejo Hospitalario Universitario, Santiago de Compostela, Spain

2Department of Microbiology, Complejo Hospitalario Universitario, Santiago de Compostela, Spain

Reprint requests and correspondence: M L Rodríguez-Méndez, MD, Department of Internal Medicine, Hospital Clínico Complejo Hospitalario Universitario, 15706 Santiago de Compostela, Spain.

Received 09 February 1999; accepted 03 December 1999

© The American College of Gastroenterology 2000. All Rights Reserved.
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