在泰国曼谷的同日开始抗逆转录病毒治疗方案中，HIV 阳性个体中乙型肝炎和丙型肝炎病毒感染的流行情况及相关因素。
Prevalence and the associated factors of hepatitis B and hepatitis C viral infections among HIV-positive individuals in same-day antiretroviral therapy initiation program in Bangkok, Thailand.
机构信息
Institute of HIV Research and Innovation, 319 Chamchuri Square Building, Fl. 11, Unit 1109-1116, Phayathai Road, Pathumwan, Bangkok, 10330, Thailand.
Department of Epidemiology, Columbia University Mailman School of Public Health, New York, USA.
出版信息
BMC Public Health. 2022 Jan 20;22(1):144. doi: 10.1186/s12889-021-12429-6.
BACKGROUND
Viral hepatitis is highly prevalent among people with HIV (PWH) and can lead to chronic liver complications. Thailand started universal hepatitis B vaccination at birth in 1992 and achieved over 95% coverage in 1999. We explored the prevalence of hepatitis B and C viral infections and the associated factors among PWH from same-day antiretroviral therapy (SDART) service at the Thai Red Cross Anonymous Clinic, Bangkok, Thailand.
METHODS
We collected baseline characteristics from PWH enrolled in the SDART service between July 2017 and November 2019. Multivariable logistic regression was performed to determine factors associated with positive hepatitis B surface antigen (HBsAg) and hepatitis C antibody (anti-HCV).
RESULTS
A total of 4011 newly diagnosed PWH who had HBsAg or anti-HCV results at baseline: 2941 men who have sex with men (MSM; 73.3%), 851 heterosexuals (21.2%), 215 transgender women (TGW; 5.4%), and 4 transgender men (0.1%). Median age was 27 years. Overall seroprevalence of HBsAg and anti-HCV were 6.0 and 4.1%, respectively. Subgroup prevalence were 6.2 and 4.7% among MSM, 4.6 and 2.4% among heterosexuals, and 9.3 and 3.7% among TGW, respectively. Factors associated with HBsAg positivity were being MSM, TGW, born before 1992, CD4 count < 200 cells/mm, and alanine aminotransferase ≥ 62.5 U/L. Factors associated with anti-HCV positivity were being MSM, age > 30 years, alanine aminotransferase ≥ 62.5 U/L, creatinine clearance < 60 ml/min, and syphilis infection.
CONCLUSIONS
Around 5-10% of newly diagnosed PWH in Bangkok had hepatitis B viral infection after 25 years of universal vaccination. Anti-HCV positivity was found in 4-5% of PWH who were MSM and TGW. As World Health Organization and Thailand national guidelines already support routine screening of hepatitis B and C viral infections in PWH and populations at increased risk of HIV including MSM and TGW, healthcare providers should reinforce this strategy and provide linkage to appropriate prevention and treatment interventions. Catch-up hepatitis B vaccination should be made available under national health coverage.
背景
艾滋病毒（HIV）感染者（PWH）中乙型肝炎病毒（HBV）和丙型肝炎病毒（HCV）的感染率很高，可导致慢性肝脏并发症。泰国自 1992 年开始为所有新生儿接种乙型肝炎疫苗，1999 年覆盖率超过 95%。我们探索了在泰国红十字会匿名诊所接受同日开始抗逆转录病毒治疗（SDART）服务的 PWH 中乙型肝炎和丙型肝炎病毒感染的流行情况及其相关因素。
方法
我们从 2017 年 7 月至 2019 年 11 月期间参加 SDART 服务的新诊断 PWH 中收集了基线特征。采用多变量逻辑回归确定与 HBsAg 阳性和抗-HCV 阳性相关的因素。
结果
共纳入了 4011 例新诊断的 PWH，他们在基线时有 HBsAg 或抗-HCV 结果：2941 例男男性行为者（MSM；73.3%），851 例异性恋者（21.2%），215 例跨性别女性（TGW；5.4%）和 4 例跨性别男性（0.1%）。中位年龄为 27 岁。HBsAg 和抗-HCV 的总血清阳性率分别为 6.0%和 4.1%。亚组的阳性率分别为 MSM 中 6.2%和 4.7%，异性恋者中 4.6%和 2.4%，TGW 中 9.3%和 3.7%。与 HBsAg 阳性相关的因素是 MSM、TGW、出生于 1992 年前、CD4 计数<200 个细胞/mm、丙氨酸氨基转移酶（ALT）≥62.5U/L。与抗-HCV 阳性相关的因素是 MSM、年龄>30 岁、ALT≥62.5U/L、肌酐清除率<60ml/min 和梅毒感染。
结论
在曼谷，25 年后，大约 5-10%的新诊断的 PWH 患有乙型肝炎病毒感染。在 MSM 和 TGW 中，有 4-5%的 PWH 抗-HCV 阳性。由于世界卫生组织和泰国国家指南已经支持对包括 MSM 和 TGW 在内的 HIV 高危人群的乙型肝炎和丙型肝炎病毒感染进行常规筛查，医疗保健提供者应加强这一策略，并为适当的预防和治疗干预措施提供联系。国家卫生覆盖范围应提供乙型肝炎疫苗补种。
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