Corma-Gómez Anaïs, Real Luis M, Fernández-Fuertes Marta, González-Serna Alejandro, Oliver Noemi, Ortega Jesús, Rincón Pilar, Rodríguez-Pineda Elena, Santos Marta, Trigo-Rodríguez Marta, Macías Juan, Pineda Juan A
Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Spain.
Unit of Immunology, Biochemistry, Molecular Biology and Surgery, Faculty of Medicine, Universidad de Málaga, Spain.
Enferm Infecc Microbiol Clin (Engl Ed). 2023 Mar;41(3):144-148. doi: 10.1016/j.eimce.2022.01.006.
To assess HAV serologic and vaccination status among people who live with HIV (PLWH), and to evaluate the impact of a vaccination-based strategy on HAV-negative patients in Seville, Spain.
Study with two time-overlapping phases: (i) cross-sectional study of HAV immunity prevalence among PLWH followed at a Spanish hospital between August 2019 and March 2020. (ii) Patients seronegative for HAV, reliably unvaccinated were included in a before-and-after quasi-experimental study, with an intervention focused on HAV vaccination according to national recommendations in force.
Six hundred and fifty-six patients were included, of which 111 [17%, 95% confidence interval (95% CI) 14-20%] were seronegative for HAV. Of these, 48 [43% (95% CI, 34-53%)] individuals were MSM. The absence of HAV immunity was attributed in 69 [62% (95% CI, 52-71%)] patients to non-referral to vaccination, followed by lack of achievement of a correct vaccination scheme [n=26; 23% (95% CI, 16-32%)]. After the program implementation, 96 [15% (95% CI, 12-18%)] individuals were seronegative (17% vs. 15%, p=0.256), of whom 42 [41% (95% CI, 32-51%)] were MSM. The absence of immunity after the intervention was mainly attributed to: adherence failure in 23 [24.0% (95% CI, 15.8-33.7%)] patients, on-course immunization scheme in 34 [33% (95% CI, 24-43%)] individuals and pending appointment at the vaccine delivery unit in 20 [20.8% (95% CI, 13.2-30.3%)] patients.
A sizeable proportion of PLWH remains susceptible for HAV infection in future outbreaks. A program based on referral to the vaccine delivery unit yields poor results, largely due to program adherence failures. New strategies are needed to increase HAV vaccination coverage.
评估艾滋病毒感染者（PLWH）的甲型肝炎血清学和疫苗接种状况，并评估基于疫苗接种的策略对西班牙塞维利亚甲型肝炎阴性患者的影响。
该研究包括两个时间重叠阶段：（i）2019年8月至2020年3月在一家西班牙医院对PLWH中的甲型肝炎免疫流行情况进行横断面研究。（ii）甲型肝炎血清学阴性且确实未接种疫苗的患者被纳入一项前后对照的准实验研究，干预措施集中在按照现行国家建议进行甲型肝炎疫苗接种。
共纳入656例患者，其中111例（17%，95%置信区间[95%CI]14 - 20%）甲型肝炎血清学阴性。其中，48例（43%[95%CI，34 - 53%]）为男男性行为者（MSM）。69例（62%[95%CI，52 - 71%]）患者甲型肝炎无免疫力归因于未被转诊接种疫苗，其次是未完成正确的疫苗接种方案[n = 26；23%（95%CI，16 - 32%）]。项目实施后，96例（15%[95%CI，12 - 18%]）个体血清学阴性（17%对15%，p = 其0.256），其中42例（41%[95%CI，32 - 51%]）为MSM。干预后无免疫力主要归因于：23例（24.0%[95%CI，15.8 - 33.7%]）患者依从性差，34例（33%[95%CI，24 - 43%]）个体疫苗接种方案正在进行中，20例（20.8%[95%CI，13.2 - 30.3%]）患者在疫苗接种单位的预约待处理。
相当一部分PLWH在未来疫情中仍易感染甲型肝炎。基于转诊至疫苗接种单位的项目效果不佳，主要原因是项目依从性差。需要新的策略来提高甲型肝炎疫苗接种覆盖率。
