Hepatitis B incidence and prevention with antiretroviral therapy among HIV-positive individuals in Uganda

Emmanuel Seremba, Victor Ssempijja, Sarah Kalibbala, Ronald H. Gray, Maria J. Wawer, Fred Nalugoda, Corey Casper, Warren Phipps, Ponsiano Ocama, David Serwadda, David L. Thomas, Steven J. Reynolds

Research output: Contribution to journalArticlepeer-review

12 Scopus citations

Abstract

Objective: Antiretroviral therapy (ART) may interfere with replication of hepatitis B virus (HBV), raising the hypothesis that HBV infection might be prevented by ART. We investigated the incidence and risk factors associated with HBV among HIV-infected adults in Rakai, Uganda. Methods: We screened stored sera from 944 HIV-infected adults enrolled in the Rakai Community Cohort Study between September 2003 and March 2015 for evidence of HBV exposure. Serum from participants who tested anti-hepatitis B core-negative (497) at baseline were tested over 3-7 consecutive survey rounds for incident HBV. Poisson incidence methods were used to estimate incidence of HBV with 95% confidence intervals (CIs), whereas Cox proportional regression methods were used to estimate hazard ratios (HRs). Results: Thirty-nine HBV infections occurred over 3342 person-years, incidence 1.17/100 person-years. HBV incidence was significantly lower with ART use: 0.49/100 person-years with ART and 2.3/100 person-years without ART [adjusted HR (aHR) 0.25, 95% CI 0.1-0.5, P<0.001], and with lamivudine (3TC) use: 0.58/100 person-years) with 3TC and 2.25/100 person-years without 3TC (aHR 0.32, 95% CI 0.1-0.7, P=<0.007). No new HBV infections occurred among those on tenofovir-based ART. HBV incidence also decreased with HIV RNA suppression: 0.6/100 person-years with 400copies/ml or less and 4.0/100 person-years with more than 400copies/ml (aHR, 6.4, 95% CI 2.2-19.0, P<0.001); and with age: 15-29 years versus 40-50 years (aHR 3.2, 95% CI 1.2-9.0); 30-39 years versus 40-50 years (aHR 2.1, 95% CI 0.9-5.3). Conclusion: HBV continues to be acquired in adulthood among HIV-positive Ugandans and HBV incidence is dramatically reduced with HBV-active ART. In addition to widespread vaccination, initiation of ART may prevent HBV acquisition among HIV-positive adults in sub-Saharan Africa.

Original languageEnglish (US)
Pages (from-to)781-786
Number of pages6
JournalAIDS
Volume31
Issue number6
DOIs
StatePublished - Mar 27 2017

Keywords

  • HIV-positive adults
  • Rakai
  • Uganda
  • hepatitis B incidence

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases

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