Prevalence, patterns, and course of past hepatitis B virus infection in intravenous drug users with HIV-1 infection

OBJECTIVE: Hepatitis B virus (HBV) and human immunodeficiency virus (HN) sh are common routes of transmission. Therefore. markers of either active or p ast HBV infection are present in many HIV-infected patients, particularly i n intravenous drug users (IDUs). The aim of this study was to analyze the s erological pattern of past HBV infection (presence or absence of anti-HBs) and the course of past HBV infection (changes in anti-HBs status, and HBV r eactivation) in two cohorts of IDUs with and without HN infection. METHODS: HBV serum markers were studied in 388 HIV-positive and 197 HIV-neg ative IDUs. Among them, 263 HN-positive and 50 HIV-negative patients with p ast HBV infection (serum HBsAg negative and anti-HBc positive, with or with out anti-HBs) were followed-up for a median of 21 and 13 months, respective ly, to detect changes in anti-HBs status and HBV reactivation. RESULTS: The prevalence of HBV infection (either active or past) was higher in HIV-positive than in HIV-negative cases (90% vs 62%, p < 0.001), even w hen stratified by years of drug use. Most cases (92% of HIV-positive and 89 % of HIV-negative) had markers of past infection. Among those patients with past HBV infection, 60% of HIV-positive and 72% of HIV-negative presented serum anti-HBs (p = 0.03). The incidence of anti-HBs loss was 1.8 cases/100 person-year in HIV-positive, and 1.8 cases/100 person-year in HIV-negative patients (RR 1.0, 95% CI 0.1-94, p = NS). Incidence of anti-HBs developmen t was 17.6 cases/100 person-year in HIV-positive and 25.6 cases/100 person- year in HIV-negative IDUs (RR, 1.5, 95% CI, 0.6-3.5, p = NS). Only one HIV- positive patient with markers of past HBV infection developed an active inf ection (0.2 events/100 person-year). CONCLUSIONS: HBV infection (either active or past) is particularly frequent in HIV-positive IDUs. Most cases have markers of past infection, isolated detection of anti-HBc (absence of anti-HBs) is more common in HIV-positive than in HIV-negative IDUs. Despite their progressive immunosuppression, bot h anti-HBs loss and HBV reactivation are rare in HIV-infected IDUs. (C) 200 0 by Am. Cell. of Gastroenterology.