Monti Bianca, Rossotti Roberto, D'Aloia Fabiana, Calzavara Daniele, Corsico Laura, Cernuschi Massimo, Puoti Massimo, Bonfanti Paolo, Soria Alessandro
School of Medicine, University of Milano-Bicocca, Monza, Italy.
Department of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy.
Sex Transm Infect. 2025 Mar 24;101(2):121-124. doi: 10.1136/sextrans-2024-056245.
Pre-exposure prophylaxis (PrEP) with emtricitabine/tenofovir to prevent HIV in individuals with hepatitis B virus (HBV) raises concerns about HBV reactivation when stopping event-driven PrEP or redundancy in HBV treatment for continuous PrEP (since tenofovir alone would be enough for HBV). Real-world data from PrEP services could provide useful epidemiological information on HBV prevalence in PrEP attendees in low-prevalence countries.
A retrospective analysis on PrEP attendees of three services in northern Italy were conducted to assess HBV prevalence among PrEP attendees and the need for primary cycle/booster dose HBV vaccination despite previous vaccination during childhood (at birth or 12 years). Risk factors possibly associated with HBV exposure were evaluated with a binary logistic regression analysis, controlling for age, gender, place of birth (Italy vs abroad) and chemsex use (as a proxy of high-risk sexual behaviour for contracting sexually transmitted infections).
Among 10 hepatitis B surface antigen (HBsAg)-positive out of 2152 PrEP attendees (0.46%), PrEP was started in 7 subjects mainly with a daily schedule, 1 has declined after counselling, 2 were lost to follow-up. Around three-fourth of the 2152 PrEP attendees were born in Italy after 1979, thus were previously vaccinated during childhood. The probability of needing a booster for low-titre HBs antibodies was higher among those vaccinated at birth with respect to those vaccinated at 12 years (OR 2.30, 95% CI 1.80 to 2.96). The risk of previous HBV exposure (resulting in either HBsAg+ or antibodies against HBV core antigen [HBcAb]+) was higher for increasing age (OR 3.07, 95% CI 2.49 to 3.78 per 10 years more) and lower for being born in Italy (OR 0.23, 95% CI 0.14 to 0.36).
Our real-world data on a large PrEP cohort suggest that, although uncommon, HBV infection in PrEP users in low-prevalence countries should be considered and managed. In addition, HBV screening offers the opportunity to expand prevention services through vaccination.
使用恩曲他滨/替诺福韦进行暴露前预防（PrEP）以预防乙型肝炎病毒（HBV）感染者感染HIV，这引发了人们对在停止事件驱动的PrEP时HBV再激活或在持续PrEP的HBV治疗中出现冗余情况的担忧（因为仅替诺福韦就足以治疗HBV）。来自PrEP服务的真实世界数据可以提供关于低流行率国家PrEP参与者中HBV流行情况的有用流行病学信息。
对意大利北部三项服务的PrEP参与者进行回顾性分析，以评估PrEP参与者中的HBV流行情况，以及尽管在儿童期（出生时或12岁时）曾接种过疫苗，但仍需要进行初级周期/加强剂量HBV疫苗接种的必要性。通过二元逻辑回归分析评估可能与HBV暴露相关的危险因素，同时控制年龄、性别、出生地（意大利与国外）和化学性行为（作为感染性传播感染的高风险性行为的替代指标）。
在2152名PrEP参与者中，有10名乙型肝炎表面抗原（HBsAg）呈阳性（0.46%），7名主要按每日方案开始PrEP治疗，1名在咨询后拒绝，2名失访。2152名PrEP参与者中约四分之三于1979年后出生在意大利，因此在儿童期曾接种过疫苗。出生时接种疫苗的人相对于12岁时接种疫苗的人，低滴度HBs抗体需要加强接种的概率更高（比值比2.30，95%置信区间1.80至2.96）。年龄越大，既往HBV暴露（导致HBsAg阳性或抗HBV核心抗原[HBcAb]阳性）的风险越高（每增加10岁，比值比3.07，95%置信区间2.49至3.78），而出生在意大利的人风险较低（比值比0.23，95%置信区间0.14至0.36）。
我们来自一大群PrEP队列的真实世界数据表明，尽管在低流行率国家PrEP使用者中HBV感染并不常见，但仍应予以考虑和管理。此外，HBV筛查为通过疫苗接种扩大预防服务提供了机会。
