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

Abstract Objective To examine the prevalence of hepatitis B virus (HBV) in people with HIV (PWH) on contemporary antiretroviral therapy (ART) and people without HIV (PWoH) and understand the risk factors in people with HIV/HBV co-infection. Design Retrospective cross-sectional study including 5,238 participants with HIV or at risk for HIV acquisition across 13 U.S. MACS/WIHS Combined Cohort Study (MWCCS) sites between 01/2018 and 12/2024. Methods The primary outcome is the prevalence of HBV infection and HIV/HBV co-infection. We defined a positive HBsAg (surface antigen) as chronic HBV infection; negative HBsAg and positive anti-HBV core antibody (anti-HBc) as recovered infection; and both negative HBsAg and anti-HBc as never infection. Prevalence of chronic and recovered HBV infection was described in different risk groups. Results In this cohort, the overall prevalence of chronic HBV was 2.4% and HIV/HBV co-infection was 3.0% among PWH. Both current and prior HBV infection was more common in men, and the prevalence of prior HBV increased with age. In PWH, 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%) were seen in individuals with chronic HBV infection compared with the other two groups. Among PWH who never had HBV infection, 40.6% lacked seroprotection against HBV. Conclusions HBV is still prevalent in PWH. HBV co-infection was associated with lower CD4+ T-cell counts and viral suppression rate in PWH. Low seroprotection rate in those without HBV underscores the need for improved screening and immunization.