HBcAb positivity increases the risk of severe hepatic fibrosis development in HIV/HCV-positive subjects from the ICONA Italian cohort of HIV-infected patients

Background: The aim of this study was to investigate the impact of anti-HBc (HBcAb) positivity on the progression of liver fibrosis (Fibrosis-4 score >3.25) in the Italian cohort of HIV-infected individuals naïve to antiretroviral treatment (ICONA). Methods: All patients with FIB-4 <3.25 at baseline were evaluated prospectively: 6966 people with HIV (PWH) were screened and classified based on hepatitis B virus (HBV) and hepatitis C virus (HCV) serology. Results: Patients who were HBcAb+/HCV-/HBs antigen (HBsAg)-and HCV+/HBcAb+/HBsAg-or HBsAg+/HBcAb+/HCV-had CD4+ cell counts below the nadir and significantly higher prevalence of AIDS diagnosis at baseline than the other groups (P <. 0001). A Cox regression model adjusted for age, HIV transmission mode, country of birth, and alcohol consumption showed a higher relative risk (HR) of progression to FIB-4 >3.25 in HCV+/HBcAb+/HBsAg-patients (HR, 7.2; 95% CI, 3 8-13.64). Conclusions: HBcAb+ contributes to liver damage in HIV+/HCV+/HBcAb+/HBsAg-subjects. A careful monitoring for signs of previous HBV infection is needed in this kind of patients.