OUTCOME OF ACUTE HEPATITIS B VIRUS INFECTION IN HIV-1 INFECTED PATIENTS: POSSIBLE FACTORS ASSOCIATED WITH RESOLUTION OR CHRONICITY

Background: Human immunodeficiency virus (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 [AOR]=0.03, 95% confidence interval [CI]: 0.001-0.58, p=0.021). Dually acting antiretroviral therapy (DAART), including one or more drugs active against HIV/HBV (lamivudine, emtricitabine, tenofovir), appeared to be protective in terms of the clinical outcome of CBI (AOR=0.07, 95% CI: 0.01-1.02, 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 DAART during AHB.