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HIV therapy helps protect men from Hep B infection

Treated HIV-positive men 80% less likely to catch Hep B – but vaccine rates must improve

Louise Prime

Tuesday, 13 October 2015

Effective drug treatment for human immunodeficiency virus (HIV) infection helps to protect men who have sex with men (MSM) from becoming infected with hepatitis B virus (HBV), researchers have found. They reported* today in Annals of Internal Medicine that the drugs appear to help restore the men’s immune system, and so protect them from acquiring HBV. But they called for more effort to be put into encouraging HBV vaccination among MSM, because HBV infection rates remain so high in this group.

Researchers led from the Johns Hopkins University School of Medicine studied 2,400 men who have sex with men, from four US cities, who were also enrolled in the Multicenter AIDS Cohort Study. When that study began in 1984, 41% of men with HIV infection had been vaccinated against HBV, compared with a vaccination rate of 28% in HIV-negative men. By the end of the study period in 2013, 60% of the men had had more than one dose of HBV vaccine (the recommendation is for three doses within six months) – and vaccination rates were 67% in HIV-positive and 58% of HIV-negative men.

HIV-positive men who were effectively treated with HIV drugs – i.e. with no detectable virus in their blood – had an 80% lower risk of having acquired HBV infection during a median follow-up period of 9.5 years, compared with HIV-positive men who were either untreated, or who still had detectable virus despite drug therapy. This meant that effective therapy had lowered their risk of HBV infection to the same level as that of HIV-negative men.

The study authors said their study had also confirmed the long-held belief that, regardless of HIV infection status, HBV vaccination protects people from acquiring a new HBV infection.

They said: “What this means to us is that effective HIV therapy appears to restore an impairment in the immune response that protects someone with HIV from acquiring hepatitis B infection.”

However, the researchers added, this ‘restoration’ of the immune system by effective HIV therapy is not enough to control the HBV epidemic in MSM. They pointed out that despite an effective HBV vaccine being available for over 30 years, thousands of new infections still occur every year – 15-25% of them among MSM – and they called for action to improve vaccination rates to control the spread of the infection in this group.

They said: “We found a 70% reduction in new HBV infections in the men who reported receiving at least one dose of HBV vaccine … [but] vaccination rates, even in high-risk individuals, such as men who have sex with men, remain low, and we need to do a better job of encouraging vaccination.”

* Falade-Nwulia O, Seaberg EC, Snider AE et al. Incident hepatitis B virus infection in HIV-infected and HIV-uninfected men who have sex with men from pre-HAART to HAART periods: a cohort study. Ann Intern Med. Published online 13 October 2015 doi:10.7326/M15-0547.

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