Impact of HIV Pre-Exposure Prophylaxis on HIV Incidence and Hepatitis B Outcomes Among Sex Workers Living With Hepatitis B: A Modelling Analysis in Côte D'Ivoire

IF 5.2 1区医学 Q2 IMMUNOLOGY

Journal of the International AIDS Society Pub Date : 2026-10-26 DOI:10.1002/jia2.70217

Amir M. Mohareb, Arthur Y. Kim, Menan Gérard Kouamé, Marcellin Nouaman, Patrick A. Coffie, Maya Hajny Fernandez, Virginia R. Talbot, Ruitian Xeno Hu, Anne M. Neilan, Anders Boyd, Kenneth A. Freedberg, Joseph Larmarange, Emily P. Hyle

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引用次数: 0

Abstract

Introduction

Nearly 10% of sex workers in sub-Saharan Africa live with chronic hepatitis B virus (HBV). HIV pre-exposure prophylaxis (PrEP) using tenofovir/emtricitabine (TDF/FTC) has not been studied in this population, possibly due to concerns of hepatitis flares following TDF/FTC cessation.

Methods

Using a microsimulation model of HIV and HBV disease and data from 2016 to 2024, we compared the clinical impact of TDF/FTC as PrEP versus no TDF/FTC among women who sell sex with HBV in Côte d'Ivoire. We incorporated the anti-HBV effects of TDF/FTC and the increased probability of hepatitis flares and HBV surface antigen (HBsAg) loss following TDF/FTC cessation. We estimated input parameters from published literature: HIV incidence (1.9–3.0 per 100 person-years), PrEP adherence (55%), disengagement from PrEP care (4% per month for the first 12 months, then 12.5% per month), hepatitis flare incidence (2.0−4.0 per 100 person-years) and rate of HBsAg loss (1.0 per 100 person-years), which both increase following TDF/FTC cessation. Model outcomes included cumulative HIV incidence, average hepatitis flares, HBsAg loss and survival over 2, 5 and 10 years. We conducted sensitivity analyses varying HIV incidence, PrEP adherence, disengagement from PrEP care and hepatitis flare rate.

Results

Compared with no TDF/FTC, TDF/FTC would reduce cumulative HIV incidence: 4.1% versus 5.6% at 2 years and 10.1% versus 12.7% at 5 years. TDF/FTC would result in more hepatitis flares (mean 0.76 vs. 0.19 per person) and more HBsAg loss (8.4% vs. 5.7%) than no TDF/FTC after 5 years. Two- and five-year survival would be similar between the two strategies, and TDF/FTC would improve survival over longer horizons. Improving adherence and reducing disengagement from care would increase clinical benefits. Even with high disengagement from care and high risk of hepatitis flares, TDF/FTC would reduce HIV acquisition and improve overall long-term survival.

Conclusions

Women who sell sex with HBV in Côte d'Ivoire would benefit from TDF/FTC as PrEP to avoid HIV acquisition. The increased risk of hepatitis flares, while challenging to manage in resource-limited settings, would be outweighed by the benefits of HIV prevention. Efforts should be made to scale up PrEP in sex workers, including women with chronic HBV.

Abstract Image

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艾滋病毒暴露前预防对乙型肝炎性工作者中艾滋病毒发病率和乙型肝炎结局的影响：Côte科特迪瓦的建模分析

撒哈拉以南非洲近10%的性工作者携带慢性乙型肝炎病毒（HBV）。尚未在该人群中研究使用替诺福韦/恩曲他滨（TDF/FTC）的HIV暴露前预防（PrEP），可能是由于担心停止TDF/FTC后肝炎发作。方法使用HIV和HBV疾病的微观模拟模型和2016 - 2024年的数据，我们比较了在Côte科特迪瓦与HBV进行性交易的妇女中，TDF/FTC作为PrEP与不使用TDF/FTC的临床影响。我们纳入了TDF/FTC的抗HBV作用，以及TDF/FTC停止后肝炎爆发和HBV表面抗原（HBsAg）丢失的可能性增加。我们从已发表的文献中估计输入参数：HIV发病率（每100人年1.9-3.0例），PrEP依从性（55%），脱离PrEP护理（前12个月每月4%，然后每月12.5%），肝炎暴发发病率（每100人年2.0 - 4.0例）和HBsAg损失率（每100人年1.0例），这两项在TDF/FTC停止后均增加。模型结果包括累计HIV发病率、平均肝炎发作、HBsAg损失和2年、5年和10年的生存率。我们对不同的HIV发病率、PrEP依从性、脱离PrEP护理和肝炎爆发率进行了敏感性分析。结果：与没有TDF/FTC相比，TDF/FTC可降低累计HIV感染率：2年4.1%比5.6%，5年10.1%比12.7%。5年后，与没有TDF/FTC相比，TDF/FTC会导致更多的肝炎发作（平均每人0.76 vs 0.19）和更多的HBsAg损失（8.4% vs 5.7%）。两种策略的2年和5年生存率相似，TDF/FTC将提高长期生存率。提高依从性和减少脱离护理将增加临床效益。即使在高脱离护理和高肝炎暴发风险的情况下，TDF/FTC也会减少艾滋病毒感染并提高总体长期生存率。结论：在Côte科特迪瓦与HBV进行性交易的妇女将受益于TDF/FTC作为预防感染艾滋病毒的预防措施。尽管在资源有限的环境中难以管理，但肝炎爆发风险的增加将被艾滋病毒预防的益处所抵消。应努力扩大性工作者，包括感染慢性乙型肝炎病毒的妇女的PrEP。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the International AIDS Society IMMUNOLOGY-INFECTIOUS DISEASES

CiteScore

8.60

自引率

10.00%

发文量

186

审稿时长

>12 weeks

期刊介绍： The Journal of the International AIDS Society (JIAS) is a peer-reviewed and Open Access journal for the generation and dissemination of evidence from a wide range of disciplines: basic and biomedical sciences; behavioural sciences; epidemiology; clinical sciences; health economics and health policy; operations research and implementation sciences; and social sciences and humanities. Submission of HIV research carried out in low- and middle-income countries is strongly encouraged.