| Background Currently, MSM is an important transmitted way of HIV infection. MSM HIV infected patients are susceptible to HBV infection, so HIV and HBV co-infection is fairly common. HBV infection among MSM HIV infected patients can easily lead to chronic infection with high viral load, rapid liver cirrhosis and high liver-related mortality[1]. Although ART can lower the mortality of AIDS-related opportunistic infections effectively, liver-related diseases has been an important cause of mortality. Understanding the characteristics of HBV infection among MSM HIV infected patients can provide basis for the effective control and prevention of the disease.Objective To explore the characteristics of HBV infection among ART-na?ve MSM HIV infected patients.Methods All the patients we studied are from an open, prospective cohort in Beijing Youan hospital. All the participants are ART-na?ve with HIV infection. We collected clinical information of all the participants and collected blood samples at a series of time points. The level of HBV DNA, ALT, AST and serological HBV markers were detected.Results 1. 183 MSM HIV infected patients were included in our study. The median time of HIV infection was 54 days(rang:14-178 days) and the median time of follow- up was 528 days(rang:147-1484 days). At the baseline, the mean ALT levels and AST levels were 23.96±5.14 ng/ml, 60.90±13.94 ng/ml, respectively. The mean CD4 T cell counts of the baseline and the end of follow-up were 502.67± 181.14 cells/μl, 415.05±182.13 cells/μl, respectively.2. Of all the 183 MSM HIV infected patients, the median age was 30 years old(rang:18-56 years). Young adults(165) accounted a large part(90.16%). 21-35 years old persons accounted for 61.75%(113 cases) and patients with low degrees accounted for 39.9%(73 cases). Compared to the past, the percent of participants who had a history of marriage and heterosexual sex increased to 37.2%(68 casas), 46.4%(85 casas), respectively.3. At the baseline in our study, 61 patients(33.3%) were HBs Ab-negative, 35 patients(19.1%) were negative for HBV markers, and 130 patients(71%) were positive for one or more HBV markers. The rate of HIV/HBV co-infection from 7.7%(14 cases) of the baseline increased to 8.7%(16 cases) of the last follow- up.4. At the acute/early phase of HIV infection, the serum ALT level s of HIV/HBV co-infected group were higher than that of HIV mono-infected group(p<0.05), while the CD4 T cell counts, AST levels had no statistical difference between the two groups(p>0.05). At the last follow-up points of the chronic HIV infection, the ALT levels, AST levels and CD4 T cell counts had no statistical difference between HIV/HBV co-infected group and HIV mono-infected group(P>0.05).5. For HBe Ag-negative HBV infection group, the positive rate of HBV DNA was 44.4%(4 cases), and the mean levels of serum HBV DNA were(4.12±3.06) Log10IU/ml at the acute/early phase of HIV infection, but to the chronic phase of HIV infection, the positive rate of HBV DNA increased to 66.7%(6 cases) and the mean levels of serum HBV DNA were(3.57±0.67) Log10IU/ml. The percent of patients with HBV DNA above 4 Log10IU/ml increased from 11.1% of acute/early phase to 22.2% of chronic phase HIV infection.6. For HBe Ag-positive HBV infection group, the mean levels of serum HBV DNA had no statistical difference between the acute/early phase and the chronic phase HIV infection(the mean levels of serum HBV DNA were(7.8±0.44) Log10IU/ml,(7.5±0.24) Log10IU/ml, respectively, P>0.05).7. At the acute/early phase of HIV infection, the serum HBV DNA loads in HBe Ag-positive HBV infection group were higher than that in HBe Ag-negative HBV infection group, but there was no significant difference between the two groups(the mean levels of serum HBV DNA were(7.8±0.44) Log10IU/ml,(4.12±3.06) Log10IU/ml, respectively, P= 0.057). However, at the chronic phase of HIV infection, the serum HBV DNA loads in HBe Ag-positive HBV infection group were significantly higher than that in HBe Ag-negative HBV infection group(the mean levels of serum HBV DNA were(7.5±0.24) Log10 IU/ml,(3.57±0.67) Log10IU/ml, P<0.001).8. There were 14 new HBV infected patients in our study, and the new HBV infection rate was 8.3%(95%CI:4.13-12.44). The rate of new HBV infection in HBV markers-negative group was significantly higher than that in HBs Abpositive, HBc Ab-positive group(P<0.008), and the rate in HBs Ab-positive group was lower than in HBs Ab-negative group(P<0.05). 15.4% of the new HBV infected patients progresssd to chronic infection.9. Among the 14 new HBV infected patients, 71.4% patients had depletions of CD4 T cell counts, and 36% had significant depletions of CD4 T cell counts before the HBV infection markers appearing. The change of CD4 T cell counts between the baseline and the last CD4 T cell count tests had a median of-6.5 cells/ul in month(IQR:-29.9-5.32), and the depletions of CD4 T cell counts had a median of 14 cells/ul in month(IQR:6-35.2). During the depletions of CD4 T cell counts, the lowest counts had a median of 382 cells/ul(IQR:332-446).10. CD4 T cell counts can affect the prevalence of HBV co-infection. The HBV co-infection rate of MSM HIV infected patients with CD4 T cell counts below 200 cells/μl was higher than those with CD4 T cell counts above 351cells/μl.11. Among ART-na?ve MSM HIV infected patients, the prevalence of occult HBV infection(OBI) was 3%(95%CI:0.4~5.51). The median age of the OBI patients was 45 years(rang: 28-54 years). 2 occult-infected patients(40%) were negative for HBV markers, 2 patients(40%) were positive for HBs Ab,HBc Ab and 1 patient(20%) was positive for isolated HBs Ab.There was no statistical difference in the prevalence of OBI among the three serum mode groups as above(χ2=0.48, P=0.79). The median serum HBV DNA levels of OBI patients were low, at 445 IU/m L [IQR: 302.5-501IU/m L; rang: 195-528 IU/m L]. 3 occult-infected patients’(75%) HBV DNA turned negative, and 1 occultinfected patient’(25%) HBV serum markers patterns turned to be HBs Agpositive, HBe Ag-positive, HBc Ab-positive and HBV DNA levels increased significantly during the follow-up period.Conclusions 1. The unmarried young adults who are 21-35 years old and with low degrees account a large part in ART-na?ve MSM HIV infected patients, but the proportion of participants with advanced degrees increases gradually. The percent of participants who have a history of marriage and heterosexual sex increased compared to the past.2. The exposure rate to HBV infection is up to 71% among ART-na?ve MSM HIV infected patients, and most of the patients still have no active immunity for HBV infection. At the acute/early phase of HIV infection, HBs Ag carry rate is similar to the general population in China, but with the progress of the HIV infection duration, HIV/HBV co-infection rate increases gradually. So we should provide conventional detection for HBV among MSM HIV infected patients and take active measures such as HBV vaccination to prevent those patients from HBV infection.3. HBV infection does not alter the immunologic progression of HIV disease. At the acute/early phase of HIV infection, the levels of serum ALT are higher in HIV/HBV co-infected group compared to HIV mono-infected group, but at the chronic phase of HIV infection, there is no significant difference in the level of serum ALT between the co-infected and mono-infected group, which indicates that as the extension of HIV infection duration, the serum ALT levels of HIV/HBV co-infection may not rise when HIV infection causes immunosuppression. So we should combine the ALT level with HBV DNA loads or lier biopsies to assess the liver damage of HIV/HBV co-infected patients.4. HBe Ag positive indicates the activity of replication of HBV in MSM HIV/HBV co-infected patients. However, as the extension of HIV infection duration, we should detect the serum HBV DNA level of HBe Ag-negative patients to assess the state of HBV infection, because the seroconversion of HBe Ag sometimes does not mean HBV stops replication or hepatitis is relieved.5. With an infection rate of 8.3%, the new HBV infection rate of HBs Ab-positive group is lower than HBs Ab-negative group, which suggests that HBs Ab can effectively prevent HBV infection among MSM HIV infected people.6. Among ART-na?ve MSM HIV infected patients, CD4 T cell counts can affect the prevalence of HBV infection. Most of the participants’ immunity is damaged before the new HBV infection, and the prevalence of HBV coinfection is higher in patients with lower CD4 T cell counts.7. ART-na?ve MSM HIV infected patients have a higher risk of chronicity after acute HBV infection.8. Among ART-na?ve MSM HIV infected patients, the prevalence of occult HBV co-infection is 3%. Occult-infected individuals tend to be older and are either positive for HBs Ab or negative for HBV serum markers. Although viral loads of HBV in OBI patients are low, they still have an increased risk of viral load rebound. |
PDF Full Text Request