HIV Coinfection Among Persons Diagnosed With Hepatitis B in England in 2008–2014

G Ireland; R Simmons; K Balogun; P Kirwan; CA Sabin; M Ramsay; V Delpech; S Mandal


HIV Medicine. 2019;20(4):255-263. 

In This Article

Abstract and Introduction


Objectives: The aim of the study was to estimate HIV prevalence among persons with hepatitis B virus (HBV) infection in England and to examine associated risk factors.

Methods: Persons aged ≥ 15 years with an HBV surface antigen (HBsAg) test reported to Public Health England (PHE) sentinel surveillance during 2008–2014 were linked to the PHE national HIV/AIDS database. Coinfection was defined as an HIV diagnosis prior to, or within 6 months following, a positive HBsAg test.

Results: During 2008–2014, 2 149 933 persons were tested for HBsAg and 3.9% (1129 of 28 789) of HBsAg-positive persons were HIV positive. The probable route of HIV infection was heterosexual exposure for 95.3% of female patients and 32.3% of male patients, with 61.5% of male patients reporting sex between men. Among African-born coinfected persons, 84% probably acquired HIV there. Predictors of HIV positivity included older age [adjusted odds ratio (aOR) 1.1] and being of black ethnicity (aOR 15.5 for males; aOR 16.4 for females) or being male and of white ethnicity (aOR 8.2) compared with being female and of white ethnicity. HIV coinfection was more likely when HBV was diagnosed in sexual health (aOR 55.0), specialist liver (aOR 6.7), emergency department (aOR 5.3) and renal services (aOR 2.8) compared with general practice. Most (60.4%; 682 of 1129) coinfected persons were diagnosed with HIV infection > 6 months before HBV diagnosis.

Conclusions: Persons testing positive for HBsAg had a low HIV infection rate and fell largely into two groups: those of black ethnicity with probable Africa-acquired infections and white men who have sex with men (MSM) with probable UK-acquired infections. Findings reinforce existing recommendations to sustain and improve both HBV testing of migrants from HBV-prevalent countries and vaccination among HIV-positive MSM. Findings also support blood-borne virus testing in sexual health services and emergency departments.


An estimated 180 000 persons are living with chronic persistent hepatitis B virus (HBV) infection and > 100 000 are living with HIV infection in the UK.[1,2] In England, the most commonly reported transmission routes for acute HBV infection are heterosexual contact (57%), followed by sex between men (16%) and injecting drug use (4%).[3] In contrast, the majority (96%) of persons diagnosed with new chronic persistent HBV infection probably acquired the infection overseas prior to arrival in the UK, having been born or brought up in countries with an intermediate or high prevalence of HBV where perinatal and childhood transmission routes are common.[4]

Almost all (> 95%) persons diagnosed with HIV infection in the UK acquired the infection sexually and men who have sex with men (MSM) are at greatest risk of acquiring HIV within the UK.[2,5]

Coinfection with HBV and HIV can impact on disease outcomes, by prolonging the period of HBV infectivity and active hepatitis, accelerating progression to cirrhosis, end-stage liver disease and hepatocellular carcinoma (HCC) and increasing liver-related mortality.[6–11] As HBV infection is vaccine-preventable, national guidelines recommend vaccination of risk groups including persons with HIV infection.[12]

The prevalence of HBV infection in HIV-infected cohorts in Europe varies, although it has generally been reported to be between 6 and 10%.[8,13–15] In the UK Collaborative HIV Cohort Study (UK CHIC), 6.7% of HIV-positive persons had a current HBV infection,[14,16] indicated by HBV surface antigen (HBsAg) testing, and, while there have been a number of estimates of HBV prevalence in persons who are HIV positive, there are no large population-based estimates of HIV prevalence among persons with HBV infection in the UK.

Using information from the sentinel surveillance of blood-borne virus testing (SSBBV) and the HIV and AIDS Reporting System (HARS) held at Public Health England (PHE), we investigated the prevalence of diagnosed HIV infection in persons testing, and testing positive, for current HBV infection. We describe the characteristics of the coinfected population and examine predictors of coinfection.