Journal of the International AIDS Society
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
Par Mohareb AM, Kim AY, Kouamé MG et 10 autres.
Contenu en anglais
Résumé
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.