Hepatitis B in men who have sex with men and HIV-infected individuals: missed opportunities and future challenges

摘要: Hepatitis B transmission in priority populations continues to occur Australia despite the availability of a safe, effective vaccine for over 30 years. In this edition Sexual Health, Body et al. report an incidence 1.8 hepatitis virus (HBV) infections per 1000 person years Victorian HIV database (VHIVSD), cohort HIV-infected individuals receiving care at tertiary referral hospital Melbourne. A similar infection (1.98 person-years) was found by Gamagedara among men who have sex with (MSM) attending community sexual health centre, also This is more than 10 times estimated general population and evidence ongoing these being part clinical cohorts therefore occurring people linked care. Both recent studies highlighted missed opportunities screening, vaccination follow-up testing ensure protection particular risk HBV infection. new reinforces need greater focus on comprehensive populations, including MSM – particularly given reports increasing practices corresponding increases sexually transmissible infections, HIV. With 218,00 (1.0% population) living chronic (CHB) 2011, generally low-prevalence country, main burden disease experienced those born overseas endemic areas, Aboriginal Torres Strait Islander people. are account ~4.4% (around 9700 individuals) CHB identified as prevention First National Strategy 2010–2013. The higher acute prevalence multifactorial. increased relates shared modes transmission, sexual, injecting drug use or both. Globally, areas high often CHB, making coinfection common countries now reside Australia. associated both developing if exposed complications, cirrhosis liver cancer. retrospective reported colleagues, 23% patients incident HBVinfection went onto develop far expected 5% progression observed immunocompetent adults. highlight further improvements access testing. study al., ascertainment immunity status but markers were less commonly tested: surface antibody (anti-HBs) tested 96% patients, compared core (anti-HBc) 79% antigen (HBsAg) 26% patients. As authors comment, incomplete raises possibility infections. Similarly, that HBsAg anti-HBc not performed 32% HIV-positive individuals. Testing Policy released 2012 recommends all three HIVinfected alternative screening algorithms can lead missing creates unnecessary vaccination, recall repeat individual panel tests (HBsAg, anti-HBs anti-HBc) Medicare rebatable advised any having CHB. For VHIVSD whom documented, median time between diagnosis 4.6 (range: 4 months 17 years). These results indicate through suggest infrequent routine determine promote vaccination. Together, they needs attention. Vaccination recommended susceptible However, eligibility funded CSIRO PUBLISHING