Incident Hepatitis B in Men with or at Risk for HIV Infection

描述（由申请人提供）：本提案的重点是多中心艾滋病队列研究（MACS）中男性乙型肝炎病毒（HBV）感染事件，这是一项针对男男性行为者（MSM）的研究。具体而言，目标包括确定在HAART前和HAART时期艾滋病毒感染者和未感染艾滋病毒的男性中发生HBV感染的趋势，并确定与这些感染的各种结果相关的因素。实现这些目标非常重要，因为肝病是艾滋病毒感染者发病和死亡的重要原因，这些数据将提供信息，使公共卫生工作重点放在预防乙型肝炎病毒传播上。第一个目标确定在不同的5年期间（包括HAART前、HAART早期和HAART后期）新发HBV感染的发生率，以确定艾滋病毒感染和未感染艾滋病毒的男男性行为者的发病率如何随时间变化。由于HAART疗法变得更加有效，其他性传播疾病在这一人群中也在增加，但没有关于HBV发病率的数据。这些数据对这一人群的公共卫生工作很重要。第二个目标将确定耐药HBV是否正在传播。MACS是研究这一问题的理想人群，因为许多艾滋病毒感染的男性正在服用抗艾滋病毒药物，这些药物对HBV也有活性，而HBV是最有可能感染耐药变体的人群。第三个目标旨在确定在HAART前和HAART时期与急性HBV感染恢复相关的因素。第四个目标将确定血清逆转的频率和与血清逆转相关的因素。总之，这项研究将提供重要的信息，以了解目前在男男性行为者中的HBV流行，以便更有效地针对公共卫生工作。

DESCRIPTION (provided by applicant): This proposal focuses on incident hepatitis B virus (HBV) infections in men in the Multicenter AIDS Cohort Study (MACS), which is a study of men who have sex with men (MSM). In particular, the goals include determining trends in incident HBV infections in HIV-infected and HIV-uninfected men during the pre-HAART and HAART eras and determining factors associated with various outcomes of these infections. These goals are important to achieve since liver disease is an important cause of morbidity and mortality in HIV-infected persons and these data will provide information to focus public health efforts on prevention of HBV transmission. The first Aim determines the incidence of new HBV infections during distinct 5 year periods that cover the pre- HAART, early HAART, and later HAART periods in order to determine how the incidence has changed over time in HIV-infected and HIV-uninfected MSM. Other sexually transmitted diseases have been increasing in this population since HAART has become more effective but data on HBV incidence do not exist. These data are important for public health efforts in this population. The second Aim will determine whether transmission of drug-resistant HBV is occurring. The MACS is an ideal population to study this since many of the HIV- infected men are on HIV drugs that are also active against HBV, which is the group most likely to be infected with a drug-resistant variant. The third Aim is designed to determine factors associated with recovery from an acute HBV infection in the pre-HAART and the HAART eras. The fourth Aim will determine the frequency of seroreversion and the factors associated with seroreversion. In summary, this study will yield important information to understand the current HBV epidemic amongst MSM in order to target public health efforts more efficiently. PUBLIC HEALTH RELEVANCE: HIV-HBV co-infection occurs in up to 10% of HIV-infected individuals and is an important public health problem since liver disease is one of the leading causes of non-AIDS mortality. Thus, prevention of incident HBV in HIV-infected persons is essential and requires understanding the transmission trends and the factors associated with outcomes of acute HBV infections. This proposal will provide such data, which will help focus public health efforts in prevention of HBV infections in men with or at risk for HIV infection.