CROI 2024 Abstract eBook

Abstract eBook

Poster Abstracts

730

Chronic Hepatitis B Increases Mortality Risk in COVID-19 While Vaccination Is Protective George A Yendewa 1 , Temitope Olasehinde 2 , Frank Mulindwa 3 , Amir M. Mohareb 4 , Jeffrey Jacobson 1 1 Case Western Reserve University, Cleveland, OH, USA, 2 University Hospitals Cleveland Medical Center, Cleveland, OH, USA, 3 United Health Services Wilson Medical Center, Johnson City, NY, USA, 4 Harvard Medical School, Boston, MA, USA Background: Chronic hepatitis B virus (HBV) infection is considered a risk factor for severe SARS-CoV-2 infection (COVID-19); however, there is conflicting evidence regarding its impact on COVID-19 outcomes in dually infected individuals. Furthermore, while COVID-19 vaccination has been associated with a lower risk of death and adverse outcomes in the general population, its effect on COVID-19 outcomes in individuals with chronic HBV infection remains unexplored. Methods: We used the TriNetX database to compare adult patients with confirmed SARS-CoV-2 infection and chronic HBV (COVID-HBV) and without chronic HBV (COVID-wo-HBV) who sought care across 77 healthcare systems in the United States from January 2020 to August 2023. We included people with HBV diagnosis codes and laboratory testing. We assessed the risk of inpatient hospitalization, intensive care unit admission, mechanical ventilation, early (30-day) and late (90-day) mortality. We further assessed the impact of COVID-19 vaccination on outcomes in subgroup analysis of COVID-HBV. We addressed potential confounders using 1:1 propensity score matching by demographics, key comorbidities, and COVID-19 vaccination. For outcomes of interest, we calculated odds ratios (OR) and 95% confidence intervals (CI), with statistical significance set at p < 0.05. Results: Of 3,360,173 individuals with confirmed SARS-CoV-2, about 0.2% (7,163) were COVID-HBV, of which 13.9% (996) were vaccinated. People with COVID-HBV had higher odds of 90-day mortality (OR 1.21, 95% CI 1.02-1.44; p = 0.032) and ICU admission (OR 1.39, 95% CI 1.17-1.66; p < 0.001) compared with COVID-wo-HBV; however, there was no significant difference between groups in 30-day mortality, hospitalization, and mechanical ventilation rates. In subgroup analysis of COVID-HBV, those who received COVID-19 vaccination had lower odds of death at 30 days (OR 0.38, 95% CI 0.22-0.66; p < 0.001) and 90 days (OR 0.46, 95% CI 0.31-0.70; p < 0.001). Vaccination was not associated with decreased odds of hospitalization, ICU admission, and mechanical ventilation rates. Conclusion: In the largest study to date, chronic HBV infection conferred higher odds of death and adverse outcomes in COVID-19. Notably, COVID-19 vaccination was associated with a significant reduction in the odds of death and the need for ICU admission, suggesting that vaccination could be an effective strategy for mitigating the impact of COVID-19 in individuals with chronic HBV infection. IL-21 Ameliorates Liver Inflammation by Enhancing MDSC Activity in Chronic HBV Infection Xiaoyi Li 1 , Zhipeng Liu 1 , Guofu Ye 1 , Shihong Zhong 1 , Shuqin Gu 2 , Libo Tang 1 , Yongyin Li 1 1 Southern Medical University Nanfang Hospital, Guangzhou, China, 2 Southern Medical University Nanfang Hospital, Guangzhou, Guangdong, China Background: In patients with chronic HBV infection, the immune response is inadequate for HBV clearance but can cause a persistent inflammatory reaction. Alleviating hepatitis may be possible by inhibiting the function of inflammatory cells during hepatitis activity. The potential for interleukin 21 (IL-21) to suppress liver inflammation by regulating the suppressive activity of myeloid-derived suppressor cells (MDSCs) on T cell response is not well understood. Methods: Eighty treatment-naïve patients with chronic HBV infection were recruited and classified into the immune tolerant carrier (IT; n = 37), hepatitis B e antigen (HBeAg)-positive chronic hepatitis B (CHB; n = 16), and inactive carrier (IC; n = 27) groups according to the American Association for the Study of Liver Diseases guidelines. Another 33 healthy controls (HCs) were also enrolled in this study. We investigated the characteristics of MDSCs and the effect of IL-21 on the phenotype and function of MDSCs by flow cytometry. The

Nigeria (8.60/1000PY, 95% CI: 4.76-15.53), Tanzania (5.61/1000PY, 95% CI: 3.26 9.66) and Uganda (3.41/1000PY, 95% CI: 1.78-6.58). South Rift Valley had the lowest incidence rate at 1.41/1000PY (95% CI: 0.70-2.81). Conclusion: We observed regional variation in the prevalence of HBV infection. We also demonstrated incident cases of Hepatitis B among adults living with HIV in Sub-Saharan Africa indicating that transmission also occurs after childhood. These findings have implications for frequency of repeat HBsAg screening in PLH in Africa, particularly where HBV vaccination status may be unknown. Loss of Serologic Response in Young People With HIV (PWH) Who Had Undergone HBV Revaccination Yi-Chia Huang, Hsin-Yun Sun, Sung-Hsi Huang, Yu-Chung Chuang, Yu-Shan Huang, Kuan-Yin Lin, Aristine Cheng, Wang-Da Liu, Chiao-Wen Huang, Wen-Chun Liu, Chien-Ching Hung National Taiwan University Hospital, Taipei, Taiwan Background: We previously have shown in a clinical trial that PWH who had achieved virologic and immunologic responses with ART and were randomized to receive three double-dose (40-µg) HBV vaccine (Engerix) achieved a significantly higher seroresponse rate (anti-HBs antibody titer ≥10 mIU/ ml) and high-titer (≥100 mIU/ml) seroresponse rate than PWH who received three standard-dose (20-µg) HBV vaccine. Factors associated with loss of seroprotection during follow-up were investigated. Methods: PWH who were born after 1986 and achieved seroresponses at Wk 28 following HBV revaccination in the trial were included in the follow-up. Loss of seroresponse was defined as testing negative for HBsAg and anti-HBc with anti-HBs titer <10 mIU/ml. The clinical characteristics at revaccination and during follow-up were analyzed, including age, sex, smoking status, CD4 count, plasma HIV RNA, and pre-vaccination anti-HBs titer. Results: 228 seroresponders (mean age, 28.5 years; median CD4, 599 cells/ mm 3 ) after HBV revaccination were included, 112 receiving standard-dose and 116 double-dose HBV vaccine. The baseline characteristics were balanced between the two groups. The median follow-up time was 2.48 and 2.04 years for PWH receiving standard-dose and PWH receiving double-dose HBV vaccine, respectively. During the follow-up, more PWH in the standard-dose group lost seroprotection than those in the double-dose group (22.3% vs 11.2%, p=0.024). Loss of high-titer seroresponse was more common for the standard-dose group than the double-dose group (43.4% vs 19.8%, p<0.001). Factors associated with loss of seroresponse during follow-up were older age (aHR, 1.14 [95% CI, 1.03 1.27]; p=0.016), lower pre-revaccination anti-HBs titer (<2.5 mIU/ml, aHR 13.23 [95% CI, 3.15-55.47], p<0.001), and HBV vaccine dose (double-dose, aHR 0.42 [95% CI, 0.21-0.90], p=0.024). People failing to achieve high-titer responses (10-99 mIU/ml) at Wk 28 were more likely to lose seroprotection during follow up (HR 27.9 [13.7-57.0], p<0.001) with a median time to lose anti-HBs titers being 1.26 years when compared with people achieved high-titer responses (≥100 mIU/ml) at Wk 28. Conclusion: Three double-dose HBV revaccination leads to more sustained seroprotection than standard-dose revaccination in PWH. For PWH who fail to achieve high-titer seroresponse after revaccination, annual follow-up of anti-HBs titers is recommended to detect the loss of seroprotection for HBV revaccination to be administered timely.

729

Poster Abstracts

731

CROI 2024 215