HIV pre-exposure prophylaxis and opportunities for vaccination against hepatitis A virus, hepatitis B virus and human papillomavirus: an analysis of the Ontario PrEP cohort study.

Autor:	McGarrity MW; Division of Infectious Diseases, St Michael's Hospital, Toronto, Ontario, Canada.; MAP Centre for Urban Health Solutions, St Michael's Hospital, Toronto, Ontario, Canada., Lisk R; AIDS Committee of Toronto, Toronto, Ontario, Canada., MacPherson P; Ottawa Hospital, Ottawa, Ontario, Canada.; University of Ottawa, Ottawa, Ontario, Canada., Knox D; Maple Leaf Medical Clinic, Toronto, Ontario, Canada., Woodward KS; Department of Medicine, McMaster University, Hamilton, Ontario, Canada.; Hamilton PrEP Clinic, Hamilton, Ontario, Canada., Reinhart J; Sherbourne Health, Toronto, Ontario, Canada., MacLeod J; 790 Bay Street Clinic, Toronto, Ontario, Canada., Bogoch II; Infectious Diseases, Toronto General Hospital, Toronto, Ontario, Canada., Clatworthy D; ARCH Clinic, Guelph, Ontario, Canada., Biondi MJ; School of Nursing, York University, Toronto, Ontario, Canada., Sullivan ST; Reseau Access Network, Sudbury, Ontario, Canada., Li ATW; Community Alliance for Accessible Treatment, Toronto, Ontario, Canada., Durrant G; Black Coalition for AIDS Prevention, Toronto, Ontario, Canada.; Health Outcome Promotion and Engagement Centre, Toronto Metropolitan University, Toronto, Ontario, Canada., Schonbe A; The PrEP Clinic, Toronto, Ontario, Canada., Ongoiba F; Africans in Partnership Against AIDS, Toronto, Ontario, Canada., Raboud J; University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada., Burchell AN; MAP Centre for Urban Health Solutions, St Michael's Hospital, Toronto, Ontario, Canada.; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada., Tan DHS; Division of Infectious Diseases, St Michael's Hospital, Toronto, Ontario, Canada darrell.tan@gmail.com.; MAP Centre for Urban Health Solutions, St Michael's Hospital, Toronto, Ontario, Canada.; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Jazyk:	angličtina
Zdroj:	Sexually transmitted infections [Sex Transm Infect] 2024 Jun 24. Date of Electronic Publication: 2024 Jun 24.
DOI:	10.1136/sextrans-2023-055961
Abstrakt:	Objectives: Populations who seek HIV pre-exposure prophylaxis (PrEP) are disproportionately affected by hepatitis A virus (HAV), hepatitis B virus (HBV) and human papillomavirus (HPV). We examined immunity/vaccination against these infections among participants in the Ontario PrEP cohort study (ON-PrEP). Methods: ON-PrEP is a prospective cohort of HIV-negative PrEP users from 10 Ontario clinics. We descriptively analysed baseline immunity/vaccination against HAV (IgG reactive), HBV (hepatitis B surface antibody >10) and HPV (self-reported three-dose vaccination). We further performed multivariable logistic regression to identify characteristics associated with baseline immunity/vaccination. We used cumulative incidence functions to describe vaccine uptake among participants non-immune at baseline. Results: Of 633 eligible participants, 59.1% were white, 85.8% were male and 79.6% were gay. We found baseline evidence of immunity/vaccination against HAV, HBV and HPV in 69.2%, 81.2% and 16.8% of PrEP-experienced participants and 58.9%, 70.3% and 10.4% of PrEP-naïve participants, respectively. Characteristics associated with baseline HAV immunity were greater PrEP duration (adjusted OR (aOR) 1.41/year, 95% CI 1.09 to 1.84), frequent sexually transmitted and bloodborne infection (STBBI) testing (aOR 2.38, 95% CI 1.15 to 4.92) and HBV immunity (aOR 3.53, 95% CI 2.09 to 5.98). Characteristics associated with baseline HBV immunity were living in Toronto (aOR 3.54, 95% CI 1.87 to 6.70) or Ottawa (aOR 2.76, 95% CI 1.41 to 5.40), self-identifying as racialised (aOR 2.23, 95% CI 1.19 to 4.18), greater PrEP duration (aOR 1.39/year, 95% CI 1.02 to 1.90) and HAV immunity (aOR 3.75, 95% CI 2.19 to 6.41). Characteristics associated with baseline HPV vaccination were being aged ≤26 years (aOR 9.28, 95% CI 2.11 to 40.77), annual income between CAD$60 000 and CAD$119 000 (aOR 3.42, 95% CI 1.40 to 8.34), frequent STBBI testing (aOR 7.00, 95% CI 1.38 to 35.46) and HAV immunity (aOR 6.96, 95% CI 2.00 to 24.25). Among those non-immune at baseline, overall cumulative probability of immunity/vaccination was 0.70, 0.60 and 0.53 among PrEP-experienced participants and 0.93, 0.80 and 0.70 among PrEP-naïve participants for HAV, HBV and HPV, respectively. Conclusions: Baseline immunity to HAV/HBV was common, and a sizeable proportion of non-immune participants were vaccinated during follow-up. However, HPV vaccination was uncommon. Continued efforts should be made to remove barriers to HPV vaccination such as cost, inclusion in clinical guidelines and provider recommendation. Competing Interests: Competing interests: DHST’s institution has received support from Abbott and Gilead for investigator-initiated research grants and from GlaxoSmithKline for industry-sponsored clinical trials. PMacP has received speaker honoraria from Merck and Gilead. IIB has consulted to Intercept: Global Public Health & Health Security. The other authors have no conflicts of interest to declare. (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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