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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
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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: morsica.giulia@hsr.it).

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.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jaids.com).

Received August 07, 2018

Accepted March 18, 2019

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