The CDC recommended regimen for HIV pre-exposure prophylaxis (PrEP) and post exposure prophylaxis (PEP) contain tenofovir DF (TDF)/ emtricitabine (FTC). Providing this medication to those infected with Hepatitis B virus (HBV) could theoretically lead to hepatitis flares and liver injury with TDF/FTC discontinuation. The prevalence of chronic active HBV infection in the United States (U.S.) is 1.1 % among foreign born and 0.14% among U.S. born. The aim of this analysis is to determine the prevalence of active HBV infection among men who have sex with men (MSM) initiating PrEP or PEP at New York City (NYC) sexual health clinics (SHC).
Hepatitis B serologies are obtained from all patients who initiate PrEP and PEP at NYC SHC. Using electronic medical record data, we examined HBV serologies, demographics, and reported sexual behavior. Patients who tested positive for hepatitis B core antibody (anti-HBc) and hepatitis B surface antigen (HBsAg) were classified as actively infected while those who tested positive for Hepatitis B surface Antibody (anti-Hbs) and anti-HBc were considered naturally immune. Patients who tested positive only for anti-HBs were classified as vaccine induced immunity. All patients who tested positive for HBsAg were matched with NYC HBV surveillance registry to determine if they were newly diagnosed.
From September 2016 to August 2017, 1142 HIV negative MSM initiated PEP and PrEP that contained TFD/FTC. HBV serologies were obtained from 1139 (99.7%). Their median age was 28 years (IQR 25-33); 30% were Hispanic, 29% were White non- Hispanic (NH) 26% were Black NH, and 6% were Asian NH. More than one third were foreign born (37%; n=424). Prevalence of HBV vaccine induced immunity was 57% (657/1139) and HBV natural immunity was 5.6% (64/1139). Six patients (0.53%, 95% CI: 0.24- 1.2 %) were actively infected with HBV. Foreign-born patients were more likely to be infected with HBV than US-born (1.2%vs. 0.14%; p<0.03). Five were considered newly diagnosed per the NYC HBV registry. All six patients were offered active referrals to HBV providers; five patients accepted.
Despite the high rate of HBV vaccine induced immunity of 57% among this MSM cohort, the prevalence of HBV active infection among US -born and foreign-born MSM initiating PEP and PrEP is similar to the national estimates Establishing access to HBV care through active referral systems to HBV providers is important, especially in clinics that provide PEP/PrEP to foreign-born MSM.