尼日利亚阿布贾和拉各斯的 HIV 感染者和高危人群中的男男性行为者和跨性别女性中的乙型肝炎病毒感染：一项横断面研究。
Hepatitis B virus infection among men who have sex with men and transgender women living with or at risk for HIV: a cross sectional study in Abuja and Lagos, Nigeria.
机构信息
Department of Epidemiology and Public Health, University of Maryland, School of Medicine, Baltimore, MD, USA.
Institute of Human Virology, University of Maryland, School of Medicine, Baltimore, MD, USA.
出版信息
BMC Infect Dis. 2021 Jul 6;21(1):654. doi: 10.1186/s12879-021-06368-1.
BACKGROUND
Despite the development of a safe and efficacious hepatitis B vaccine in 1982, the hepatitis B virus (HBV) remains a public health burden in sub-Saharan Africa. Due to shared risk factors for virus acquisition, men who have sex with men (MSM) and transgender women (TGW) living with HIV are at increased risk of HBV. We estimated the prevalence of HBV and associated factors for MSM and TGW living with or without HIV in Nigeria.
METHODS
Since March 2013, TRUST/RV368 has recruited MSM and TGW in Abuja and Lagos, Nigeria using respondent driven sampling. Participants with HIV diagnosis, enrollment as of June 2015, and available plasma were selected for a cross-sectional study and retrospectively tested for hepatitis B surface antigen and HBV DNA. Logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for factors associated with prevalent HBV infection.
RESULTS
A total of 717 MSM and TGW had a median age of 25 years (interquartile range [IQR]: 21-27), 5% self-reported HBV vaccination, 61% were living with HIV, 10% had prevalent HBV infection and 6% were HIV-HBV co-infected. HIV mono-infected as compared to HIV-HBV co-infected had a higher median CD4 T cell count [425 (IQR: 284-541) vs. 345 (IQR: 164-363) cells/mm, p = 0.03] and a lower median HIV RNA viral load [4.2 (IQR: 2.3-4.9) vs. 4.7 (IQR: 3.9-5.4) logcopies/mL, p < 0.01]. The only factor independently associated with HBV was self-report of condomless sex at last anal intercourse (OR: 2.2, 95% CI: 1.3, 3.6). HIV infection was not independently associated with HBV (OR: 1.0, 95% CI: 0.7-1.6).
CONCLUSION
HBV prevalence was moderately high but did not differ by HIV in this cohort of MSM and TGW. Recent condomless sex was associated with elevated HBV risk, reinforcing the need to increase communication and education on condom use among key populations in Nigeria. Evaluating use of concurrent HIV antiretroviral therapy with anti-HBV activity may confirm the attenuated HBV prevalence for those living with HIV.
背景
尽管 1982 年开发了一种安全有效的乙型肝炎疫苗，但乙型肝炎病毒（HBV）在撒哈拉以南非洲仍然是一个公共卫生负担。由于获得病毒的共同风险因素，感染艾滋病毒的男男性行为者（MSM）和跨性别女性（TGW）面临着更高的 HBV 感染风险。我们评估了尼日利亚 MSM 和 TGW 中 HBV 的流行率以及与 HIV 相关的因素。
方法
自 2013 年 3 月以来，TRUST/RV368 使用应答者驱动抽样法在阿布贾和拉各斯招募了 MSM 和 TGW。选择具有 HIV 诊断，2015 年 6 月之前入组且有可用血浆的参与者进行横断面研究，并对乙型肝炎表面抗原和 HBV DNA 进行回顾性检测。使用逻辑回归模型估计与 HBV 感染相关的因素的比值比（OR）和 95%置信区间（CI）。
结果
共有 717 名 MSM 和 TGW 中位年龄为 25 岁（四分位距[IQR]：21-27），5%的人报告接种过乙型肝炎疫苗，61%的人感染了 HIV，10%的人感染了 HBV，6%的人同时感染了 HIV 和 HBV。与 HIV-HBV 共感染相比，HIV 单感染组的中位 CD4 T 细胞计数更高[425（IQR：284-541）vs. 345（IQR：164-363）细胞/mm，p=0.03]，HIV RNA 病毒载量中位数更低[4.2（IQR：2.3-4.9）vs. 4.7（IQR：3.9-5.4）logcopies/mL，p<0.01]。唯一与 HBV 独立相关的因素是最近肛交时无保护性行为（OR：2.2，95%CI：1.3，3.6）。HIV 感染与 HBV 无独立相关性（OR：1.0，95%CI：0.7-1.6）。
结论
在 MSM 和 TGW 这一队列中，HBV 的流行率适中，但与 HIV 无差异。最近无保护性行为与 HBV 风险增加有关，这加强了在尼日利亚向重点人群进行有关安全套使用的宣传和教育的必要性。评估同时使用具有抗 HIV 活性的抗 HBV 治疗是否可以证实 HIV 感染者中 HBV 流行率降低。
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