title: Hepatitis B incidence and prevention with antiretroviral therapy among HIV-positive individuals in Uganda.
abstract: Antiretroviral therapy (ART) may interfere with replication of hepatitis B virus (HBV), raising the hypothesis that HBV infection might be prevented by ART. We investigated the incidence and risk factors associated with HBV among HIV-infected adults in Rakai, Uganda.
  
  
  
  We screened stored sera from 944 HIV-infected adults enrolled in the Rakai Community Cohort Study between September 2003 and March 2015 for evidence of HBV exposure. Serum from participants who tested anti-hepatitis B core-negative (497) at baseline were tested over 3-7 consecutive survey rounds for incident HBV. Poisson incidence methods were used to estimate incidence of HBV with 95% confidence intervals (CIs), whereas Cox proportional regression methods were used to estimate hazard ratios (HRs).
  
  
  
  Thirty-nine HBV infections occurred over 3342 person-years, incidence 1.17/100 person-years. HBV incidence was significantly lower with ART use: 0.49/100 person-years with ART and 2.3/100 person-years without ART [adjusted HR (aHR) 0.25, 95% CI 0.1-0.5, P < 0.001], and with lamivudine (3TC) use: 0.58/100 person-years) with 3TC and 2.25/100 person-years without 3TC (aHR 0.32, 95% CI 0.1-0.7, P =  < 0.007). No new HBV infections occurred among those on tenofovir-based ART. HBV incidence also decreased with HIV RNA suppression: 0.6/100 person-years with 400 copies/ml or less and 4.0/100 person-years with more than 400 copies/ml (aHR, 6.4, 95% CI 2.2-19.0, P < 0.001); and with age: 15-29 years versus 40-50 years (aHR 3.2, 95% CI 1.2-9.0); 30-39 years versus 40-50 years (aHR 2.1, 95% CI 0.9-5.3).
  
  
  
  HBV continues to be acquired in adulthood among HIV-positive Ugandans and HBV incidence is dramatically reduced with HBV-active ART. In addition to widespread vaccination, initiation of ART may prevent HBV acquisition among HIV-positive adults in sub-Saharan Africa.
authors.affiliation: aSchool of Medicine, Makerere University College of Health Sciences, Kampala, Uganda bClinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, Maryland, USA cRakai Health Sciences Program, Kalisizo, Uganda dJohns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA eFred Hutchinson Cancer Research Center and University of Washington, Seattle, Washington, USA fSchool of Public Health, Makerere University College of Health Sciences, Kampala, Uganda gJohns Hopkins University School of Medicine, Baltimore hDivision of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Seremba
authors.forename: Victor
authors.initials: V
authors.lastname: Ssempijja
authors.forename: Sarah
authors.initials: S
authors.lastname: Kalibbala
authors.forename: Ronald H
authors.initials: RH
authors.lastname: Gray
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Wawer
authors.forename: Fred
authors.initials: F
authors.lastname: Nalugoda
authors.forename: Corey
authors.initials: C
authors.lastname: Casper
authors.forename: Warren
authors.initials: W
authors.lastname: Phipps
authors.forename: Ponsiano
authors.initials: P
authors.lastname: Ocama
authors.forename: David
authors.initials: D
authors.lastname: Serwadda
authors.forename: David L
authors.initials: DL
authors.lastname: Thomas
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Reynolds
mesh_terms: D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D018890:Chemoprevention / Q000379:methods*; D015331:Cohort Studies; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006509:Hepatitis B / Q000453:epidemiology* / Q000517:prevention & control*; D006510:Hepatitis B Antibodies / Q000097:blood; D015994:Incidence; D012307:Risk Factors; D014454:Uganda / Q000453:epidemiology
chemical_list: D044966:Anti-Retroviral Agents; D006510:Hepatitis B Antibodies