HIV Treatment Can Significantly Lower Risk of Hepatitis B in HIV-Positive MSM

A new study shows that HIV-positive men who have sex with men (MSM) can lower their risk of hepatitis B virus (HBV) infection by 80% if they have antiretroviral treatment resulting in undetectable levels of HIV. Effective HIV treatment reduced these men's HBV risk to the same level seen in HIV-negative MSM. Moreover, at least one dose of the hepatitis B vaccine (three within six months are recommended) gave all MSM, regardless of HIV status, significantly boosted HBV protection.

Hepatitis B is a common coinfection with HIV. As many as one-quarter of new hepatitis B infections in the United States are among MSM, with sexual transmission a leading cause. Detectable HIV can contribute to HBV replication, and in turn, lead to mortality and illness from liver disease, underscoring the value of effective prevention.

"Just one dose of the hepatitis B vaccine resulted in a 70% reduction in risk for hepatitis B," study leader Oluwaseun Falade-Nwulia, M.D., an assistant professor of medicine at Johns Hopkins University School of Medicine, told TheBody.com. "What's disconcerting is that vaccination rates are small," she said.

At the start of the study in 1984, 41% of men with HIV (and only 28% without) had received more than one dose of the HBV vaccine. By 2013, the total percentage of vaccinated men had risen to 60% (67% with HIV/58% without), leaving a significant number of men still vulnerable to infection. Falade-Nwulia said that MSM should ask their primary care doctors for the vaccine, as well as stay on highly active antiretroviral therapy.

"Without getting vaccinated for hepatitis B, it will prove difficult to control the HBV epidemic," Falade-Nwulia emphasized. "Education needs to be stepped up in both MSM and physicians about the need for it."

The importance of getting the HBV vaccine is underscored by the finding in the study that (without taking into account other factors) MSM with HIV had double the risk of acquiring HBV compared to MSM not infected with HIV. Other risk factors found to increase the likelihood of acquiring HBV were being younger than 40 years old and having two or more sexual partners in the past six months.

Results from the study were published online Oct. 13 in the Annals of Internal Medicine.

MSM should know that the hepatitis B vaccine is covered by most insurance as part of primary care, reminded Donna Futterman, M.D., director of the Adolescent AIDS Program at the Albert Einstein College of Medicine in New York City, in an email.

The Multicenter AIDS Cohort study has been tracking this group of 2,375 MSM since 1984 in four cities: Baltimore/District of Columbia, Chicago, Pittsburgh, and Los Angeles. The men with HIV did not have HIV or hepatitis B when they entered the study. For this study, the men were followed for slightly less than ten years -- to the date of HBV infection, their last follow-up visit or Dec. 2013.

Laura Newman is a medical writer who writes frequently about chronic illnesses, including HIV, as well as health policy. She can be reached at newman@nasw.org.