Positive hepatitis B core antibody is associated with liver fibrosis in people with HIV independently of metabolic dysfunction-associated steatotic liver disease (MASLD)
Dong Hyun Kim, MD 1; Felice Cinque, MD 2; Dana Kablawi, MD, MSc 1; Thierry Fotsing Tadjo, BSc 1; Michael Nudo1; Giada Sebastiani, MD 2
1Department of Medicine, McGill University Health Center, Montreal QC
2Division of Gastroenterology and Hepatology, Department of Medicine, McGill University Health Centre, Montreal QC

Presenting Author:
Dong Hyun Kim
dong.kim4@mail.mcgill.ca
1-514-222-6663

Background: People with HIV (PWH) are at high risk for liver fibrosis and MASLD, and they also have high prevalence of positive hepatitis B virus (HBV) markers. Previous exposure to HBV may increase the risk of liver fibrosis and clinical outcomes in patients with chronic hepatitis C and MASLD, but this is unknown in PWH.

Purpose: We aimed to study the effect of previous HBV infection on liver fibrosis and clinical outcomes in PWH.

Method: This was a single centre cohort study of PWH from the LIVEr disease in HIV (LIVEHIV) Cohort. Consecutive patients with available transient elastography with controlled attenuation parameter and at least 1 year follow-up were included. Anti-Hepatitis B core antibody (anti-HBc) was used to detect the previous HBV infection. We excluded patients with chronic hepatitis C and B. MASLD was defined as the presence of hepatic steatosis, diagnosed as CAP>248 dB/m, plus any among type 2 diabetes, overweight (BMI>25 Kg/m2) or two other metabolic risk abnormalities. The outcome of interest was significant liver fibrosis, defined as liver stiffness >8 kPa. Logistic regression was used to assess cofactors of liver fibrosis. We explored association with clinical outcomes (all-cause mortality, liver-related or cardiovascular events).

Results: We included 706 PWH. Prevalence of MASLD and liver fibrosis were 36% and 21%, respectively. Significant liver fibrosis was more prevalent in PWH with positive anti-HBc compared to negative (25% vs. 17%, p=0.01) while no difference in MASLD prevalence was observed. After adjustments, positive anti-HBc was independently associated with significant liver fibrosis (adjusted odds ratio 1.54, 95% CI 1.01-2.69) (see Table). At a mean follow-up of 2.5 years, patients with positive anti-HBc had a higher incidence of all-cause mortality (1% vs 0.2%; p=0.04), cardiovascular events (8 vs 5%; p=0.02) but not of liver-related events.

Conclusion: Positive anti-HBc predicts liver fibrosis in PWH, independently of MASLD. PWH with positive anti-HBc may also have higher incidence of all-cause mortality and cardiovascular events.