Hepatitis A Outbreak in Men Who Have Sex with Men Using Pre-Exposure Prophylaxis and People Living with HIV in Croatia, January to October 2022

Bogdanić, Nikolina; Begovać, Josip; Močibob, Loris; Zekan, Šime; Grgić, Ivana Hebrang; Ujević, Josip; Rode, Oktavija Đaković; Lepej, Snježana Židovec

doi:10.3390/v15010087

Cited by 6 publications

(2 citation statements)

References 33 publications

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“…Subsequently, the incidence of hepatitis A in Croatia (2019: nine cases; 2020: five cases; 2021: five cases) was similar to 2016 ( n = 5 cases) and prior to that period. However, in 2022, a distinct cluster of HAV genotype IA-positive MSM (HIV-infected and users of pre-exposure prophylaxis) had also been characterized in Croatia [ 47 ].…”

Section: Persons With High-risk Sexual Behaviormentioning

confidence: 99%

Seroprevalence Trends and Molecular Epidemiology of Viral Hepatitis in Croatia

Vilibić-Čavlek

Lepej

Ferenc

et al. 2023

Life

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Viral hepatitis is a significant cause of morbidity and mortality worldwide. In Croatia, hepatitis B virus (HBV) and hepatitis C virus (HCV) are widely distributed, especially in some high-risk groups such as people who inject drugs (PWID), prisoners, and highly promiscuous groups. The seroprevalence of HBV ranges from 7.0% in the general population to 38.8% in PWID, depending on the region. The seroprevalence of HCV is highest among PWID (29–75.5%) as compared to 0.9% in the general population. Analyzing the distribution of HCV genotypes, no substantial changes in the molecular epidemiology of the two most frequent HCV genotypes (1 and 3) in the past 20 years were observed. However, the predominance of subtype 1b compared to subtype 1a as detected in 1996–2005 was not confirmed in 2008–2015. Hepatitis A virus (HAV) incidence was high in the past with a decreasing trend since the 2000s, except for an outbreak in 2017–2018 as part of the large European outbreak, which was mainly among men who have sex with men. Hepatitis E virus (HEV) is an emerging virus detected for the first time in Croatia in 2012. The seroprevalence of HEV is high among hemodialysis patients (27.9%) and liver transplant recipients (19.3–24.4%). In addition, higher seroprevalence rates were observed in animal-related professions (e.g., veterinarians, 15.2%; hunters, 14.9%). All detected HEV strains belonged to genotype 3.

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Section: Persons With High-risk Sexual Behaviormentioning

confidence: 99%

Seroprevalence Trends and Molecular Epidemiology of Viral Hepatitis in Croatia

Vilibić-Čavlek

Lepej

Ferenc

et al. 2023

Life

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“…Local outbreaks of hepatitis A in adults have been reported in high income countries among MSM, linked to anal sex [18][19][20][21] . These surges are a reminder of inadequate vaccination for this preventable viral disease.…”

Section: Hepatitis Amentioning

confidence: 99%

Viral hepatitis in persons living with HIV in the post-COVID era

Soriano¹,

Moreno-Torres²,

Mendoza³

et al. 2024

AIDSRev

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Coinfection with hepatitis viruses A to E is frequent in persons living with HIV (PLWH) and causes significant morbidity and mortality. Oro-fecal transmissible hepatitis A and E mostly produce acute self-limited episodes in poor income regions and in non-vaccinated travelers. In high-income countries, outbreaks of hepatitis A occur in men having sex with men (MSM) and chronic hepatitis E is occasionally reported among PLWH with severe immunodeficiency. Chronic hepatitis B, C, and D are frequent in PLWH in highly endemic regions and globally in persons who inject drugs (PWID) and MSM. Progression to liver cirrhosis and development of hepatocellular carcinoma (HCC) is major clinical complications in coinfected patients. Current estimates for PLWH are of 38 million worldwide. Roughly 12% have chronic viral hepatitis (5 million). Coinfection figures are of 5-10% for HBV (2-4 million), 4% for HCV (1.5 million), and 15% of HBsAg+ for HDV (0.5 million). Oral direct-acting antivirals (DAA) cure almost all treated patients with hepatitis C. However, given that there is no protective HCV immunity, PLWH with high-risk behaviors may experience HCV reinfection episodes. Tenofovir is the drug of choice in PLWH with chronic hepatitis B, given its dual effect on HIV and HBV. Lifelong oral tenofovir suppresses HBV replication and ameliorate liver damage. However, the risk of HCC persists even in the absence of cirrhosis. Finally, HDV causes the worst of viral hepatitis with faster progression to cirrhosis and HCC. An entry inhibitor, bulevirtide, has recently been approved and another drug, lonafarnib, is completing Phase 3 trials. Combination antiviral therapy for hepatitis D could improve dramatically the poor prognosis of HIV-HDV coinfected patients. The resumption of good medical practices in PLWH after the big disruption caused by COVID-19 will reduce the burden of viral hepatitis coinfections. Renewed efforts on HAV and HBV vaccination of susceptible individuals and earlier and wider prescription of antiviral therapy for HBV, HCV, and/or HDV coinfection should be prioritized in PLWH. The benefits of innovative strategies for viral hepatitis, including pre-exposure prophylaxis or use of long-acting antivirals, warrant further consideration in PLWH.

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