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Brief Report

Outcome of Acute Hepatitis B Virus Infection in HIV-1–Infected Patients

Possible Factors Associated With Resolution or Chronicity

Morsica, Giulia MDa; Galli, Laura MSca; Bossolasco, Simona MDa; Bagaglio, Sabrina MSca; Vercesi, Riccardo MSca,b; Salpietro, Stefania AOTa; Hasson, Hamid MDa; Messina, Emanuela MDa; Castagna, Antonella MDc; Uberti-Foppa, Caterina MDc

JAIDS Journal of Acquired Immune Deficiency Syndromes: October 1, 2019 - Volume 82 - Issue 2 - p 175–180
doi: 10.1097/QAI.0000000000002106
Clinical Science

Background: HIV-1 infection impairs cellular immunity, causing a detrimental effect on the natural course of hepatitis B virus (HBV) infection. HBV vaccination is less effective in HIV-1–infected patients. This study aimed to gain insight into HIV-1 infection with persistence of hepatitis B surface antigen (HBsAg) defining chronic hepatitis B infection (CBI) after a primary infection and the possible associated factors.

Setting: Division of Infectious Diseases, San Raffaele Hospital, Italy.

Methods: This retrospective study analyzed HIV-1–infected patients diagnosed with acute hepatitis B infection (AHB) based on clinical or laboratory records. CBI was defined as a positive HBsAg result recorded >6 months after an AHB diagnosis. Multivariate logistic regression was applied to assess factors (evaluated at AHB diagnosis) that were associated with CBI.

Results: Of 63 HIV-1–infected patients with AHB, 23 (36.5%) developed CBI. On multivariate analysis, CBI risk was less likely in patients with HIV-RNA of >50 copies/mL (adjusted odds ratio = 0.03, 95% confidence interval: 0.001 to 0.58, P = 0.021). Dually acting antiretroviral treatment, including one or more drugs active against HIV/HBV (lamivudine, emtricitabine, and tenofovir), seemed to be protective in terms of the clinical outcome of CBI (adjusted odds ratio = 0.07, 95% confidence interval: 0.01 to 1.02, P = 0.050). Among the 23 patients with CBI, 15 (65.2%) lost the hepatitis B e-antigen, while 11 (47.8%) had HBsAg seroclearance during follow-up.

Conclusions: In HIV-1–infected subjects with AHB, the persistence of HBsAg seemed to occur frequently. Factors associated with a lower CBI risk were detectable HIV load and the use of dually acting antiretroviral treatment during AHB.

aDepartment of Infectious Diseases, IRCCS Ospedale San Raffaele, Milan, Italy;

bDepartment of Biotechnology and Biosciences, University of Milano-Bicocca, Milan, Italy; and

cVita Salute University, San Raffaele, Milan, Italy.

Correspondence to: Giulia Morsica, MD, Division of Infectious Diseases, Via Stamira D'Ancona, 20, 20127 Milan, Italy (e-mail:

C.A. has received consultancy payments and speaking fee from Bristol-Myers Squibb, Gilead, AbbVie, ViiV Healthcare, Merck Sharp & Dohme, and Janssen-Cilag. The remaining authors have no conflicts of interest to disclose.

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Received August 07, 2018

Accepted March 18, 2019

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