Vaccination and Anti-HIV Therapy Lower Hepatitis B

OCD

[B]Vaccination and Anti-HIV Therapy Lower Hepatitis B Infection Rates [/B]
By Will Boggs, MD

Vaccination and antiretroviral therapy lower the very high rates of hepatitis B virus (HBV) infection among HIV-infected patients, according to a report in the August 15th issue of The Journal of Infectious Diseases.

The incidence of acute HBV infection is approximately 0.033 cases per 1000 person-years in the general population, with about 0.4% of the general population having chronic HBV infection, the authors explain. Data are limited about rates of HIV and HBV coinfection since highly active antiretroviral therapy (HAART) for HIV infection became available.

Dr. Scott E. Kellerman and colleagues from Centers for Disease Control and Prevention in Atlanta investigated the incidence of acute HBV and prevalence of chronic HBV, vaccination rates, and potential risk factors in the 16,248 HIV-infected subjects enrolled in the Adult/Adolescent Spectrum of HIV Disease Project.

Among these HIV-infected patients, rates were much higher than in the general population for acute HBV incidence (12.2 cases per 1000 patient-years) and for chronic HBV prevalence (7.6%), the authors report.

The incidence of acute HBV infection was higher among black subjects, subjects with a history of alcohol abuse in the 6 months before an observation, and among those who injected drugs, the report indicates. On the other hand, incidence rates were lower among patients treated with HAART (with or without lamivudine) and among those who had received at least one dose of hepatitis B vaccination.

Chronic HBV infection was more prevalent among men than among women, the researchers note, and was most prevalent among men who had sex with men and were intravenous drug users and was least prevalent among Hispanics.

Antiretroviral drug regimens that contained lamivudine were associated with a much lower prevalence of chronic HBV (2.3%) than were regimens that did not contain lamivudine (7.8%), the results indicate. Prevalence was 22.1% among subjects not treated with antiretroviral drugs.

"Considering the amount of time that many HIV-positive persons spend in the medical care system, it is unfortunate that many are not being adequately assessed regarding their HBV (and hepatitis A virus, for that matter) immunization status," Dr. Kellerman told Reuters Health.

"We found that only 14% of HIV positive persons had been previously vaccinated against HBV, despite recommendations for HBV vaccination in HIV-positive persons that have been available for years," he added.

Dr. Kellerman advises physicians to "ask your HIV-positive patients if they've been immunized against HBV, and if they haven't or can't remember, consider immunizing. HIV-positive persons can still be at risk for blood-borne or sexually transmitted infections."

8/25/03

J Infect Dis 2003;188:571-577.