Incidence of Chronic Hepatitis B Virus Infection Among People With HIV in Yunnan Province, China: A Retrospective Observational Cohort Study (2004–2024)

Background: Hepatitis B virus (HBV) exacerbates mortality and morbidity in individuals with human immunodeficiency virus (HIV), but limited research has been conducted on incidence of HBV in people with HIV (PWH). Methods: We herein conducted a retrospective cohort study of PWH in Yunnan province, China. PWH who underwent antiretroviral therapy (ART) and whose status was initially negative for hepatitis B surface antigen (HBsAg) were enrolled and followed-up with from 2004 to 2024 to analyze chronic HBV infection incidence and associated factors. Results: A total of 40 086 HBsAg-negative PWH underwent at least 1 follow-up test, contributing to a cumulative observation time of 221 049.8 person-years (PYs). Of the included individuals, 894 chronic HBV infections were identified, corresponding to a HBsAg-emia incidence of 2.23%, resulting in an overall incidence rate of 0.40 per 100 PYs (95% CI: 0.38-0.43). We ascertained that individuals who acquired their infection as an injectable drug user (adjusted hazard ratio [aHR, 1.50]) and who exhibited low ART adherence (aHR, 1.46) were primarily associated with a higher incidence of chronic HBV infection. Those individuals who were enrolled post-2014 (aHR, 0.81) were linked to a lower incidence of HBV, indicating a 19% relative reduction in chronic HBV infection compared to those enrolled pre-2014. Conclusions: The reduction may have been linked to factors such as introduction of hepatitis B vaccination, a decrease in proportion of HIV infections transmitted through injectable drugs, and improved effectiveness of ART. We posit that our efforts should focus in the future on enhancing immunization, treatment, and behavior intervention in this population.