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Liu R, Yang L, Jiang T, Lu Y, Zhang L, Shen G, Wu S, Chang M, Hao H, Hu L, Gao Y, Xu M, Chen X, Yi W, Li M, Xie Y. Hepatitis B core-related antigen serum levels may be a predictor of acute flare of chronic hepatitis B among pregnant women in the immune-tolerant phase of chronic HBV infection after short-course antiviral therapy. Virulence 2023; 14:2186335. [PMID: 36864005 PMCID: PMC10012896 DOI: 10.1080/21505594.2023.2186335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Studies have shown acute flares of chronic hepatitis B (CHB) might be related to immunologic changes that occur during pregnancy. However, the indicators for predicting acute flares of CHB among pregnant women still need further study. We aimed to distinguish the relevance between serum levels of HBcrAg and acute flares of CHB in pregnant women in the immune-tolerant phase of chronic HBV infection after short-course antiviral therapy. METHODS A total of 172 chronic HBV-infected pregnant women who were judged to be in the immune-tolerant phase were recruited in our research. All patients received short-course antiviral therapy with TDF. The biochemical, serological, and virological parameters were measured using standard laboratory procedures. The serum levels of HBcrAg were tested by ELISA. RESULTS Fifty-two (30.2%) out of 172 patients had acute flares of CHB. At postpartum week 12 (TDF cessation), serum HBcrAg (OR, 4.52; 95% CI, 2.58-7.92) and HBsAg (OR, 2.52; 95% CI, 1.13-5.65) were associated with acute flares of CHB. The serum HBcrAg levels were beneficial for confirmation of patients with acute flares of CHB, with an area under the ROC curve of 0.84 (95% CI, 0.78-0.91). CONCLUSIONS For pregnant women with chronic HBV infection in the immune-tolerant phase, serum HBcrAg and HBsAg levels at postpartum week 12 were associated with acute flares of CHB after short-course antiviral therapy with TDF. The serum HBcrAg level can correctly identify acute flares of CHB and may be a predictor of the need for continuing antiviral therapy after 12 weeks postpartum.
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Affiliation(s)
- Ruyu Liu
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Liu Yang
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Tingting Jiang
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yao Lu
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Lu Zhang
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Ge Shen
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Shuling Wu
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Min Chang
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Hongxiao Hao
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Leiping Hu
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yuanjiao Gao
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Mengjiao Xu
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Xiaoxue Chen
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Wei Yi
- Department of Obstetrics and gynecology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Minghui Li
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yao Xie
- Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China
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2
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Armstrong HL, Scholfield C, Symonds Y, Nadarzynski T, Graham CA. Reasons for incomplete STI vaccination among men who have sex with men in an English sexual health service. Int J STD AIDS 2023:9564624231165078. [PMID: 36943686 DOI: 10.1177/09564624231165078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND In England, vaccination for human papillomavirus, hepatitis A, and hepatitis B is recommended for men who have sex with men (MSM). However, uptake is sub-optimal and some men do not complete all recommended vaccine doses. This service evaluation aimed to explore reasons for lack of uptake for each of these vaccines among MSM in one English sexual health service and to inform improvements in service delivery to increase full dose completion rates. METHODS MSM, ≥18 years, who had previously attended NHS Solent Sexual Health for at least one vaccination, and who had not completed the full dosing regimen for at least one of these vaccines, were invited to participate in an anonymous, online survey between 14/12/2020-11/04/2021. RESULTS Among 246 MSM (M = 42.1 years), the most common reason for non-vaccination was that participants thought it was unneeded and had not been recommended by a doctor or healthcare provider. None reported vaccine hesitancy. Likewise, the most common reasons for vaccination were doctor/healthcare provider recommendation (51.7-65.6%) and self-protection (60.9-68.1%). The most common reason for not having completed the full course of vaccination was being unaware that the next dose was due (30.0-37.8%). Many participants who had not completed vaccination indicated that a doctor/healthcare provider recommendation would be a motivating factor and that reminder messages and being able to book subsequent appointments in advance would facilitate vaccination. CONCLUSIONS Sexual health clinicians should be encouraged to discuss STI vaccination with MSM and services should explore possibilities to improve ease and access to vaccine appointments to increase uptake and completion rates.
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Affiliation(s)
- Heather L Armstrong
- Solent NHS Sexual Health Service, Southampton, UK
- 7423University of Southampton, Southampton, UK
| | | | - Ynez Symonds
- Solent NHS Sexual Health Service, Southampton, UK
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3
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Brady M, Rodger A, Asboe D, Cambiano V, Clutterbuck D, Desai M, Field N, Harbottle J, Jamal Z, McCormack S, Palfreeman A, Portman M, Quinn K, Tenant-Flowers M, Wilkins E, Young I. BHIVA/BASHH guidelines on the use of HIV pre-exposure prophylaxis (PrEP) 2018. HIV Med 2020; 20 Suppl 2:s2-s80. [PMID: 30869189 DOI: 10.1111/hiv.12718] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Michael Brady
- Consultant in Sexual Health and HIV, King's College Hospital, London
| | - Alison Rodger
- Reader and Honorary Consultant Infectious Diseases and HIV, University College London
| | - David Asboe
- Consultant HIV and Sexual Health, Chelsea and Westminster Hospital NHS Foundation Trust, London
| | - Valentina Cambiano
- Lecturer in Infectious Disease Modelling and Biostatistics, University College London
| | | | - Monica Desai
- Consultant Epidemiologist, Public Health England
| | - Nigel Field
- Senior Lecturer, Consultant Clinical Epidemiologist, University College London
| | | | | | - Sheena McCormack
- Professor of Clinical Epidemiology, MRC Clinical Trials Unit at University College London
| | - Adrian Palfreeman
- Consultant HIV and Sexual Health, University Hospitals of Leicester NHS Trust
| | - Mags Portman
- Consultant HIV and Sexual Health, Mortimer Market Centre, London
| | - Killian Quinn
- Consultant HIV and Sexual Health, King's College Hospital, London
| | | | - Ed Wilkins
- Consultant in Infectious Diseases, North Manchester General Hospital
| | - Ingrid Young
- Chancellor's Fellow, Usher Institute, University of Edinburgh
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4
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Plunkett J, Mandal S, Balogun K, Beebeejaun K, Ngui SL, Ramsay M, Edelstein M. Hepatitis A outbreak among men who have sex with men (MSM) in England, 2016-2018: The contribution of past and current vaccination policy and practice. Vaccine X 2019; 1:100014. [PMID: 31384736 PMCID: PMC6668220 DOI: 10.1016/j.jvacx.2019.100014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 01/21/2019] [Accepted: 02/15/2019] [Indexed: 11/29/2022] Open
Abstract
Background We report on an outbreak of hepatitis A among men who have sex with men (MSM) in England and its associated healthcare resource burden, the strategies used to control the outbreak and the role of past and current hepatitis A vaccination policy and practice in England. Methods National surveillance of hepatitis A, including reference laboratory confirmation and molecular sequencing, and a case questionnaire, was enhanced in 2017 to collect demographic and risk information, disease severity and healthcare utilisation. National Health Service (NHS) data was used to calculate associated healthcare costs. Results During the outbreak period (July 2016 to January 2018), 670 confirmed cases were identified in England, caused by three distinct viral strains. The public health response included raising public and professional awareness, reinforcing vaccine recommendations for MSM, contact tracing for post-exposure vaccination, and mass community vaccination where spill-over of infection into the general population occurred. Hepatitis A vaccine was centrally procured to ensure sexual health clinics in England could offer vaccination to MSM. Outbreak associated healthcare costs were estimated to be approximately £1,500,000. Conclusions While MSM are at increased risk of hepatitis A infection, inconsistent implementation of MSM vaccination policy in previous years led to an increasingly susceptible MSM population. The large number of cases, hospital admission rate and public health actions contributed to a significant healthcare burden. Recommending hepatitis A vaccination for MSM and clarifying commissioning responsibilities is essential to prevent future outbreaks.
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Affiliation(s)
- James Plunkett
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, UK
| | - Sema Mandal
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, UK
| | - Koye Balogun
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, UK
| | - Kazim Beebeejaun
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, UK
| | - Siew Lin Ngui
- Blood Borne Virus Unit, Virus Reference Department, National Infection Service, Public Health England, UK
| | - Mary Ramsay
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, UK
| | - Michael Edelstein
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, UK
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5
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Affiliation(s)
- Lisa Long
- The Haven Camberwell; King's College Hospital; London SE5 9RS UK
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6
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Tomkins A, Lee V. Intervention to improve management of acute hepatitis C infection in a UK sexual health clinic. Int J STD AIDS 2017; 29:195-197. [DOI: 10.1177/0956462417727193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
A case note review was conducted for all newly-diagnosed acute hepatitis C virus (HCV)-infected patients attending our sexual health clinic pre- and post-implementation of an HCV clinic proforma between January 2010 and September 2016. In total, 87 patient notes were included (40 pre-intervention, 47 post-intervention) of whom 81 were HIV-positive. Data were collected regarding documentation of the following: baseline investigations, four-weekly HCV viral load monitoring, risk assessment, partner notification, advice given and Public Health England (PHE) notification. Appropriate baseline investigations, four-weekly monitoring of HCV viral loads, risk assessment and advice documentation all improved in the post-intervention group when compared to pre-intervention. PHE notification and partner notification remained below the national standard post-intervention, with educational measures among relevant staff implemented accordingly. This audit demonstrates improvement across several key areas post clinic proforma implementation.
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Affiliation(s)
- A Tomkins
- The Hathersage Centre, The Northern Contraception, Sexual Health and HIV Service, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - V Lee
- The Hathersage Centre, The Northern Contraception, Sexual Health and HIV Service, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
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7
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Beebeejaun K, Degala S, Balogun K, Simms I, Woodhall SC, Heinsbroek E, Crook PD, Kar-Purkayastha I, Treacy J, Wedgwood K, Jordan K, Mandal S, Ngui SL, Edelstein M. Outbreak of hepatitis A associated with men who have sex with men (MSM), England, July 2016 to January 2017. ACTA ACUST UNITED AC 2017; 22. [PMID: 28183392 PMCID: PMC5388117 DOI: 10.2807/1560-7917.es.2017.22.5.30454] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 02/02/2017] [Indexed: 11/20/2022]
Abstract
Between July 2016 and January 2017, 37 confirmed cases of hepatitis A with two unique IA genotype strains primarily among men who have sex with men, were reported across eight areas in England and Northern Ireland. Epidemiological and laboratory investigations indicate that these strains may have been imported several times from Spain, with secondary sexual transmission in the United Kingdom. Local and national public health services are collaborating to control this ongoing outbreak.
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Affiliation(s)
- Kazim Beebeejaun
- Immunisation, Hepatitis and Blood Safety department, National Infection Service, Public Health England, Colindale, London, United Kingdom
| | - Srilaxmi Degala
- Field Epidemiology Services East Midlands, Public Health England, United Kingdom
| | - Koye Balogun
- Immunisation, Hepatitis and Blood Safety department, National Infection Service, Public Health England, Colindale, London, United Kingdom
| | - Ian Simms
- HIV and STI department, National Infection Service, Public Health England, Colindale, London, United Kingdom
| | - Sarah Charlotte Woodhall
- HIV and STI department, National Infection Service, Public Health England, Colindale, London, United Kingdom
| | - Ellen Heinsbroek
- Field Epidemiology Services London, Public Health England, United Kingdom
| | - Paul David Crook
- Field Epidemiology Services London, Public Health England, United Kingdom
| | - Ishani Kar-Purkayastha
- Hampshire & Isle of Wight Health Protection Team (South East), Public Health England, United Kingdom
| | - Juli Treacy
- Hampshire & Isle of Wight Health Protection Team (South East), Public Health England, United Kingdom
| | - Kate Wedgwood
- East Midlands Health Protection Team, Public Health England, United Kingdom
| | - Kate Jordan
- South West Health Protection Team, Public Health England, United Kingdom
| | - Sema Mandal
- Immunisation, Hepatitis and Blood Safety department, National Infection Service, Public Health England, Colindale, London, United Kingdom
| | - Siew Lin Ngui
- Virus Reference Department, Public Health England, Colindale, London, United Kingdom
| | - Michael Edelstein
- Immunisation, Hepatitis and Blood Safety department, National Infection Service, Public Health England, Colindale, London, United Kingdom
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8
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Bamford A, Tudor-Williams G, Foster C. Post-exposure prophylaxis guidelines for children and adolescents potentially exposed to HIV. Arch Dis Child 2017; 102:78-83. [PMID: 27974330 DOI: 10.1136/archdischild-2015-309297] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 04/24/2016] [Accepted: 06/04/2016] [Indexed: 11/04/2022]
Abstract
UK guidelines for HIV post-exposure prophylaxis (PEP) in adults have recently been updated. Indications for PEP have been modified and there has been a change in the recommended antiretroviral therapy for adults to a combination of raltegravir with tenofovir and emtricitabine (Truvada). Raltegravir and tenofovir are now available in paediatric formulations and offer improved safety and tolerability over previously recommended ritonavir-boosted lopinavir with zidovudine. This guideline provides recommendations for those caring for children potentially exposed to HIV and other bloodborne viruses in primary care, emergency departments, secondary care and specialist paediatric HIV centres.
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Affiliation(s)
- Alasdair Bamford
- Department of Paediatric Infectious Diseases, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Gareth Tudor-Williams
- Department of Paediatric Infectious Diseases, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Caroline Foster
- Department of Paediatric Infectious Diseases, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
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9
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Affiliation(s)
- R Gilson
- Centre for Sexual Health And HIV Research, Royal Free and University College Medical School, The Mortimer Market Centre, London WC1E 6AU, UK.
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