目标:寻求HIV暴露前预防(PrEP)的人群不成比例地受到甲型肝炎病毒(HAV)的影响,乙型肝炎病毒(HBV)和人乳头瘤病毒(HPV)。我们在安大略省PrEP队列研究(ON-PrEP)中检查了针对这些感染的免疫/疫苗接种。
方法:ON-PrEP是来自安大略省10个诊所的HIV阴性PrEP使用者的前瞻性队列。我们描述性分析了针对HAV(IgG反应性)的基线免疫/疫苗接种,HBV(乙型肝炎表面抗体>10)和HPV(自我报告的三剂量疫苗接种)。我们进一步进行了多变量逻辑回归,以确定与基线免疫/疫苗接种相关的特征。我们使用累积发生率函数来描述基线时非免疫参与者的疫苗摄取。
结果:在633名符合条件的参与者中,59.1%为白色,85.8%为男性,79.6%为同性恋。我们发现了针对HAV的免疫/疫苗接种的基线证据,HBV和HPV在69.2%,有PrEP经验的参与者分别为81.2%和16.8%和58.9%,70.3%和10.4%的PrEP天真的参与者,分别。与基线HAV免疫相关的特征是PrEP持续时间更长(校正OR(aOR)1.41/年,95%CI1.09至1.84),频繁性传播和血源性感染(STBBI)检测(aOR2.38,95%CI1.15至4.92)和HBV免疫(aOR3.53,95%CI2.09至5.98)。与基线HBV免疫相关的特征生活在多伦多(aOR3.54,95%CI1.87至6.70)或渥太华(aOR2.76,95%CI1.41至5.40),自我识别为种族化(AOR2.23,95%CI1.19至4.18),PrEP持续时间更长(AOR1.39/年,95%CI1.02至1.90)和HAV免疫(aOR3.75,95%CI2.19至6.41)。与基线HPV疫苗接种相关的特征是年龄≤26岁(aOR9.28,95%CI2.11至40.77),年收入在6万加元至119万加元之间(AOR3.42,95%CI1.40至8.34),频繁的STBBI检测(aOR7.00,95%CI1.38至35.46)和HAV免疫(aOR6.96,95%CI2.00至24.25)。在那些基线时没有免疫的人中,在有PrEP经验的参与者中,免疫/疫苗接种的总累积概率分别为0.70、0.60和0.53,在PrEP-na-iveHAV参与者中,免疫/疫苗接种的总累积概率分别为0.93、0.80和0.70,HBV和HPV,分别。
结论:对HAV/HBV的基线免疫是常见的,相当比例的非免疫参与者在随访期间接种了疫苗.然而,HPV疫苗接种并不常见。应继续努力消除HPV疫苗接种的障碍,如成本,纳入临床指南和提供者推荐。
OBJECTIVE: 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.