Prevalence of Hepatitis B co-infection in people with HIV by birth cohort

Background Availability of the hepatitis B virus (HBV) vaccine in the U.S. since 1982 and recommendations for universal/catch-up vaccination of infants and children since the 1990s may be associated with lower HBV prevalence among people with HIV (PWH) born post-1980. Methods Active HBV infection prevalence defined as proportion with a positive HBsAg result was assessed among PWH at entry into a clinical cohort. Patients were categorized into birth cohorts of 1940-1959, 1960-1979 and 1980-1999 and then further dichotomized into pre- and post-1980 cohorts. Log binomial regression was used to assess the association of birth cohort with HBsAg positivity adjusting for race/ethnicity, HIV infection risk factor, baseline HIV viral load and CD4 count, HBV active therapy, and year of/age at cohort entry. Results Among 5598 PWH, most were male (67%) and Black (77%), with a mean age of 39.7 (SD 9.6) years at cohort entry. Approximately a third (30%) of the participants identified as MSM and 39% reported a history of IDU. At cohort entry, the majority had a CD4 count <350 cells/mm3 and viral load >1000 c/ml. Overall, HBV prevalence was 6.7% but varied by birth cohort: 1940 to 1959, 6.2%; 1960 to 1979, 7.9% and 1980 to 1999, 2.6%. HBV infection risk was lower in the post-1980 birth cohort compared to the pre-1980 birth cohort (adjusted prevalence ratio = 0.19; 95% CI: 0.09, 0.42). Conclusion PWH born after 1980 had a lower prevalence of HBV coinfection than those born before 1980, supporting the potential impact of universal childhood HBV vaccination.