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.
Division of Infectious Diseases, San Raffaele Hospital, Italy.
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.
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.
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: email@example.com).
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