Distinct Hepatitis B and HIV co‐infected populations in Canada

Abstract

Due to shared modes of exposure, HIV‐HBV co‐infection is common worldwide. Increased knowledge of the demographic and clinical characteristics of the co‐infected population will allow us to optimize our approach to management of both infections in clinical practice. The Canadian Hepatitis B Network Cohort was utilized to conduct a cross‐sectional evaluation of the demographic, biochemical, fibrotic and treatment characteristics of HIV‐HBV patients and a comparator HBV group. From a total of 5996 HBV‐infected patients, 335 HIV‐HBV patients were identified. HIV‐HBV patients were characterized by older median age, higher male and lower Asian proportion, more advanced fibrosis and higher anti‐HBV therapy use (91% vs. 30%) than the HBV‐positive / HIV seronegative comparator group. A history of reported high‐risk exposure activities (drug use, high‐risk sexual contact) was more common in HIV‐HBV patients. HIV‐HBV patients with reported high‐risk exposure activities had higher male proportion, more Caucasian ethnicity and higher prevalence of cirrhosis than HIV‐HBV patients born in an endemic country. In the main cohort, age ≥60 years, male sex, elevated ALT, the presence of comorbidity and HCV seropositivity were independent predictors of significant fibrosis. HIV seropositivity was not an independent predictor of advanced fibrosis (adj OR 0.75 [95%CI: 0.34–1.67]). In conclusion, Canadian co‐infected patients differed considerably from those with mono‐infection. Furthermore, HIV‐HBV‐infected patients who report high‐risk behaviours and those born in endemic countries represent two distinct subpopulations, which should be considered when engaging these patients in care.

HBeAg Levels Vary across the Different Stages of HBV Infection According to the Extent of Immunological Pressure and Are Associated with Therapeutic Outcome in the Setting of Immunosuppression-Driven HBV Reactivation

“…Notably, qHBeAg was the biomarker showing the strongest negative correlation with ALT, specifically in the setting of acute infection and chronic hepatitis. This result is in keeping with a recent study showing an inverse correlation of HBeAg levels with ALT and APRI scores in patients with chronic HBV hepatitis [25]. It is known that HBeAg can act as a tolerogen and immunomodulator, thus jeopardizing the establishment of a fully effective immune response against the virus [5].…”

Sexual Dimorphism in Chronic Hepatitis B Virus (HBV) Infection: Evidence to Inform Elimination Efforts

“…Pre-menopausal females with CHB are at a lower risk of chronic liver disease compared to males, as exemplified by a cohort of 672 patients in Switzerland, in which liver-related outcomes were significantly less common in females (OR 0.35, 95% CI 0.20-0.60) 40 . Similarly, in a Canadian study of nearly 6000 patients with HBV infection, male sex was an independent predictor of advanced liver fibrosis 41 .…”

Severe Hepatic Steatosis Is Associated With Low-Level Viremia and Advanced Fibrosis in Patients With Chronic Hepatitis B in North America

“…Among the 6709 patients in the Canadian Hepatitis B Network database, 24 1433 (21.4%) had CAP scores recorded. Two hundred fifty-five patients were excluded owing to other viral coinfections (ie, hepatitis C, hepatitis D, and HIV), 27,28 alcohol misuse disorder, other liver disease (eg, autoimmune), or HBsAg clearance. 29 In total, 1178 patients monoinfected with HBV were included for analysis (median age: 47.4 years, 57.7% male, 75.7% Asian, 13% African, 6.5% White, and 5.1% other ethnicity), out of whom 86% were HBeAg negative, median HBV DNA of 2.44 log 10 IU/mL (interquartile range: 2.55interquartile range), and 42.7% underwent antiviral treatment (Table 1).…”