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HIV antiretroviral therapy may protect MSM against HBV

In a study of men who have sex with men enrolled in the Multicenter AIDS Cohort Study, researchers reported that men effectively treated for HIV were least likely to develop hepatitis B virus infection compared with untreated men, according to published findings in Annals of Internal Medicine.

“What this means to us is that effective HIV therapy appears to restore an impairment in the immune response that protects someone with HIV from acquiring hepatitis B infection,” Chloe Thio, MD, professor of medicine, Johns Hopkins University School of Medicine, said in a press release.

Chloe Thio

To determine the incidence rate and predictors for HBV before and after highly active antiretroviral therapy (HAART), Thio and colleagues, including Oluwaseun Falade-Nwulia, MD, MPH, assistant professor of medicine, Johns Hopkins University School of Medicine, evaluated data of 2,375 MSM with or at risk for HIV without HBV. Of the men, 75% did not have HIV, 25% had HIV and 8.5% of the men who did not have HIV underwent HIV seroconversion. The men underwent testing for hepatitis B surface antigen, hepatitis B core antibody and hepatitis B surface antibodies to determine HBV positivity.

All the men had 25,322 person-years of follow-up, during which 244 cases of HBV developed with an overall unadjusted HBV incidence rate (IR) of 9.6 per 1,000 person-years. Among men with HIV, there were 94 cases of HBV in 6,301 per 1,000 person-years (IR = 14.9; 95% CI, 12.2-18.3) compared with 150 cases of HBV in 19,020 per 1,000 person-years in men without HIV (IR = 7.8; 95% CI, 6.7-9.3).

A higher percentage of men with HIV (41%) reported receiving at least one dose of the HBV vaccine compared with men without HIV at baseline (28%; P < .001). This increased by the end of the study period among the men with HIV (67%) and those without (58%).

“We found a 70% reduction in new HBV infections in the men who reported receiving at least one dose of HBV vaccine,” Falade-Nwulia, said in the release. “Vaccination rates, even in high-risk individuals, such as men who have sex with men, remain low, and we need to do a better job of encouraging vaccination.”

To further evaluate the effects of HAART therapy on HBV incidence, IRs were separated based on HAART therapy and HIV RNA to MSM only followed during the HAART era. The researchers found that the IR for men on HAART with HIV RNA less than 400 copies/mL was similar to the IR of men without HIV during the same era (2.6 vs. 3.1; P = .69). This IR was also lower than the IR among men undergoing HAART with HIV RNA of at least 400 copies/mL (P < .001) and similar to the rate of men with HIV not undergoing HAART with an HIV RNA of at least 400 copies/mL.

According to the press release, these findings indicate that MSM with HIV treated effectively with HAART were 80% less likely to get HBV over a median follow-up of approximately 9.5 years compared with men with HIV who did not undergo HIV therapy or men who had detectable HIV virus while on HIV therapy.

Univariate analysis showed HIV infection to be associated with incidence of HBV (IRR = 2.4; 95% CI, 1.8-3.1), along with age younger than 40 years and a person having  two or more sexual partners in 6 months prior to the study.

The researchers concluded: “Effective HAART is associated with reduced rates of incident HBV in HIV-infected men to rates similar to those seen in HIV-infected men, highlighting an additional benefit of achieving an undetectable HIV RNA amongst HIV-infected patients. However, even amongst HIV-uninfected MSM or HIV-infected MSM with well-controlled HIV, incident HBV rates remain unacceptably high.” – by Melinda Stevens

Disclosures: Healio.com/Hepatology was unable to confirm relevant financial disclosures at the time of publication.