High Prevalence of Hepatitis B in People With HIV in the MWCCS, 2018-2024

This study aimed to examine the prevalence of hepatitis B virus (HBV) in people with HIV (PWH) undergoing contemporary antiretroviral therapy and people without HIV and to understand the risk factors in people with HIV/HBV coinfection. This retrospective cross-sectional study included 5238 participants with HIV or at risk for HIV acquisition across 13 US sites in the MACS/WIHS Combined Cohort Study (Multicenter AIDS Cohort Study / Women Interagency HIV Study) between January 2018 and December 2024.

The primary outcome was the prevalence of HBV infection and HIV/HBV coinfection. We defined a positive HBsAg (surface antigen) as chronic HBV infection, a negative HBsAg and positive anti-HBV core antibody as recovered infection, and a negative HBsAg and negative anti-HBV core antibody as never infection. The prevalence of chronic and recovered HBV infection was described in different risk groups.

In this cohort, the overall prevalence of chronic HBV was 2.4%, and HIV/HBV coinfection was 3.0% among PWH. Current and prior HBV infection was more common in men, and the prevalence of prior HBV increased with age. As compared with the other 2 groups, PWH with chronic HBV infection had lower CD4+ T-cell counts (567 vs 651 and 689 cells/µL), CD4+ T-cell nadirs (210 vs 245 and 258 cells/µL), and HIV viral suppression rate (71.7% vs 82.3% and 83.7%). Among PWH who never had HBV infection, 40.6% lacked seroprotection against HBV.

HBV is still prevalent in PWH. HBV coinfection was associated with lower CD4+ T-cell counts and viral suppression rate in PWH. The low seroprotection rate in those without HBV underscores the need for improved screening and immunization.