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Original Research |

Incident Hepatitis B Virus Infection in HIV-Infected and HIV-Uninfected Men Who Have Sex With Men From Pre-HAART to HAART Periods: A Cohort StudyIncident HBV Infection in MSM

Oluwaseun Falade-Nwulia, MD, MPH; Eric C. Seaberg, PhD; Anna E. Snider; Charles R. Rinaldo, PhD; John Phair, MD; Mallory D. Witt, MD; and Chloe L. Thio, MD
[+] Article, Author, and Disclosure Information

This article was published online first at www.annals.org on 13 October 2015.


From Johns Hopkins University, Baltimore, Maryland; University of Pittsburgh, Pittsburgh, Pennsylvania; Feinberg School of Medicine, Northwestern University, Chicago, Illinois; and Los Angeles Biomedical Research Institute at Harbor–University of California, Los Angeles Medical Center, Torrance, California.

Grant Support: By the National Institute of Allergy and Infectious Diseases, with additional funding from the National Cancer Institute (UO1-AI-35042, UL1-RR025005, UO1-AI-35043, UO1-AI-35039, UO1-AI-35040, UO1-AI-35041, UL1TR000124, and R03AI096918).

Disclosures: Dr. Seaberg reports grants from the National Institutes of Health during the conduct of the study. Dr. Phair reports grants from the National Institutes of Health during the conduct of the study and personal fees from Pfizer outside the submitted work. Dr. Thio reports grants from the National Institutes of Health during the conduct of the study and grants from Gilead Sciences outside the submitted work. Authors not listed here have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOf InterestForms.do?msNum=M15-0547.

Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer.

Reproducible Research Statement:Study protocol: Available at www.statepi.jhsph.edu/macs/macs.html. Statistical code: Available from Dr. Falade-Nwulia (e-mail, ofalade1@jhmi.edu). Data set: Available from Dr. Seaberg (e-mail, ecs@jhu.edu).

Requests for Single Reprints: Oluwaseun Falade-Nwulia, MD, MPH, Johns Hopkins University, 725 North Wolfe Street, Room 215, Baltimore, MD 21205; e-mail, ofalade1@jhmi.edu.

Current Author Addresses: Dr. Falade-Nwulia: Johns Hopkins University, 725 North Wolfe Street, Room 215, Baltimore, MD 21205.

Dr. Seaberg: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Room E-7634, Baltimore, MD 21205.

Ms. Snider and Dr. Thio: Johns Hopkins University, 855 North Wolfe Street, Room 533, Baltimore, MD 21231.

Dr. Rinaldo: University of Pittsburgh Graduate School of Public Health, A419 Crabtree Hall, 130 DeSoto Street, Pittsburgh, PA 15261.

Dr. Phair: Department of Medicine, Feinberg School of Medicine, 645 North Michigan Avenue, Suite 900, Chicago, IL 60611.

Dr. Witt: Los Angeles Biomedical Research Institute at Harbor–University of California, Los Angeles Medical Center, 1124 West Carson Street, Building CDCRC, Torrance, CA 90502.

Author Contributions: Conception and design: O. Falade-Nwulia, E.C. Seaberg, C.R. Rinaldo, C.L. Thio.

Analysis and interpretation of the data: O. Falade-Nwulia, E.C. Seaberg, C.L. Thio.

Drafting of the article: O. Falade-Nwulia, E.C. Seaberg, C.L. Thio.

Critical revision of the article for important intellectual content: O. Falade-Nwulia, E.C. Seaberg, C.R. Rinaldo, M.D. Witt, C.L. Thio.

Final approval of the article: O. Falade-Nwulia, E.C. Seaberg, A.E. Snider, C.R. Rinaldo, J. Phair, M.D. Witt, C.L. Thio.

Provision of study materials or patients: M.D. Witt.

Statistical expertise: O. Falade-Nwulia, E.C. Seaberg.

Obtaining of funding: C.L. Thio.

Administrative, technical, or logistic support: E.C. Seaberg, J. Phair.

Collection and assembly of data: A.E. Snider, M.D. Witt, C.L. Thio.


Ann Intern Med. 2015;163(9):673-680. doi:10.7326/M15-0547
Text Size: A A A

Background: Men who have sex with men (MSM) are at high risk for hepatitis B virus (HBV) infection. Data on the effect of highly active antiretroviral therapy (HAART) on incident HBV infection in HIV-infected and HIV-uninfected MSM are limited.

Objective: To determine predictors of incident HBV infection in MSM during pre-HAART and HAART periods.

Design: Observational cohort study.

Setting: Cohort of MSM who have, or are at risk for, HIV infection.

Patients: 2375 HBV-uninfected MSM in the Multicenter AIDS Cohort Study.

Measurements: Poisson regression was used to compare incidence rates of HBV infection in the pre-HAART and HAART eras and to identify factors associated with incidence of HBV infection.

Results: In 25 322 person-years of follow-up, 244 incident HBV infections occurred. The unadjusted incidence rate was higher in HIV-infected MSM than in HIV-uninfected MSM (incidence rate ratio [IRR], 1.9 [95% CI, 1.5 to 2.4]) and was significantly lower in the HAART era than in the pre-HAART era among HIV-infected (IRR, 0.2 [CI, 0.1 to 0.4]) and HIV-uninfected (IRR, 0.3 [CI, 0.2 to 0.4]) MSM. Age younger than 40 years (IRR, 2.3 [CI, 1.7 to 3.0]), more than 1 recent sexual partner (IRR, 3.1 [CI, 2.3 to 4.2]), and HIV infection (IRR, 2.4 [CI, 1.8 to 3.1]) were independently associated with higher incidence of HBV infection, whereas HBV vaccination was protective (IRR, 0.3 [CI, 0.2 to 0.4]). Highly active antiretroviral therapy with HIV RNA levels less than 400 copies/mL was associated with protection (IRR, 0.2 [CI, 0.1 to 0.5]), but HAART in those with HIV RNA levels of 400 copies/mL or greater was not.

Limitation: The observational nature limits inferences about causality.

Conclusion: Effective HAART is associated with lower incidence of HBV infection; however, even in the HAART era, incidence of HBV infection remains high among MSM.

Primary Funding Source: National Institute of Allergy and Infectious Diseases.

Figures

Grahic Jump Location
Figure.

Incidence rate of HBV infection, stratified by HIV infection and HAART use status.

The incidence rate and 95% CI are represented for each HIV/HAART group. HAART = highly active antiretroviral therapy; HBV = hepatitis B virus; PY = person-year.

Grahic Jump Location

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