Hepatitis B incidence and prevention with antiretroviral therapy among HIV positive individuals in Rakai, Uganda.

Publication Type:

Journal Article


AIDS (London, England) (2017)


OBJECTIVE: Antiretroviral therapy (ART) may interfere with replication of hepatitis B (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-HBc 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 while Cox proportional regression methods were used to estimate hazard ratios.

RESULTS: 39 HBV infections occurred over 3,342 person-years (p-y), incidence 1.17/100 p-y. HBV incidence was significantly lower with ART use: (0.49 /100 p-y) with ART and (2.3/100 p-y) without ART [aHR = 0.25 (95% CI, 0.1-0.5) p < 0.001], and with lamivudine (3TC) use: (0.58/100 p-y) with 3TC and (2.25/100 p-y) without 3TC [aHR = 0.32(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 p-y) with ≤400 copies/mL and (4.0/100 py) with >400 copies/mL [aHR = 6.4(2.2-19.0), p < 0.001] and with age: 15-29 years vs 40-50 years [aHR = 3.2 (1.2-9.0)]; 30-39 years vs 40-50 years [aHR = 2.1(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.