Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2022 Dec 28;15(1):87.
doi: 10.3390/v15010087.

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

Nikolina Bogdanić  1 , Josip Begovac  1   2 , Loris Močibob  1 , Šime Zekan  1   2 , Ivana Grgić  1 , Josip Ujević  1 , Oktavija Đaković Rode  1   3 , Snježana Židovec-Lepej  1
Affiliations
Review

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

Nikolina Bogdanić et al. Viruses. .

Abstract

The hepatitis A virus (HAV) is a highly hepatotropic virus transmitted mainly via the fecal-oral route. The purpose of this study is to describe a prolonged HAV outbreak in HIV-infected men who have sex with men (MSM) and pre-exposure prophylaxis (PrEP) users in Croatia in 2022. Croatia has a centralized system of HIV care and the PrEP service is only available at the University Hospital for Infectious Diseases (UHID), Zagreb. We reviewed all MSM living with HIV and MSM PrEP users at UHID and identified those diagnosed with HAV between January and October 2022. During this period, a total of 1036 MSM living with HIV and 361 PrEP users were followed, and 45 (4.4%) and 32 (8.9%) were diagnosed with HAV, respectively. Most cases were diagnosed in mid-February. A total of 70.1% (726/1036) MSM living with HIV and 82.3% (297/361) PrEP users were susceptible to HAV. Sequencing information was available for 34 persons; in all cases the HAV subtype IA was found. Our findings indicate that both MSM living with HIV and HIV-uninfected PrEP users are vulnerable to HAV infection and might be a potential source for a more widespread HAV epidemic.

Keywords: HIV; epidemic; hepatitis A; men who have sex with men; pre-exposure prophylaxis.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Epidemic curve of total hepatitis A cases among men who have sex with men (MSM) who use pre-exposure prophylaxis (PrEP) and MSM living with HIV (PLWH), January–October 2022 according to weeks, Croatia (n = 77).
Figure 2
Figure 2
Proportion of individuals susceptible to hepatitis A virus infection according to age, January–October 2022, Croatia. Data for 10 MSM living with HIV and 3 HIV uninfected MSM were unknown. The p-value from the Cochrane–Armitage trend test was the same for both MSM PrEP users and MSM living with HIV.
Figure 3
Figure 3
Phylogenetic tree of the VP1/P2A region of the HAV genome constructed using a maximum likelihood method, Tamura–Nei model showing three distinct clusters: Croatian2022 sequences (marked in red), RIVM-HAV-090 strain sequences (EuroPride, 2018, in black) and VRD_521_2016 sequences (UK/Spain, 2017–2018, blue).
Figure 4
Figure 4
Number of cases of hepatitis A in EU/EEA countries by age groups, ECDC 2016 to 2021. Source: https://www.ecdc.europa.eu/en/hepatitis-a/surveillance/atlas, access date 5 November 2022.
See this image and copyright information in PMC

References

    1. European Centre for Disease Prevention and Control . ECDC. Annual Epidemiological Report for 2016. ECDC; Stockholm, Sweden: 2019. [(accessed on 5 November 2022)]. Hepatitis A. Available online: https://www.ecdc.europa.eu/en/publications-data/hepatitis-annual-epidemi....
    1. Narodne Novine Pravilnik o načinu provođenja imunizacije, seroprofilakse, kemoprofilakse protiv zaraznih bolesti te o osobama koje se moraju podvrgnuti toj obvezi; Zagreb, Narodne novine d.d. 2013; No 103/2013. [(accessed on 5 November 2022)]. p. 2322.
    1. ECDC . Epidemiological Update: Hepatitis A Outbreak in the EU/EEA Mostly Affecting Men Who Have Sex with Men. ECDC; Stockholm, Sweden: 2018. Available online: https://www.ecdc.europa.eu/en/news-events/epidemiological-update-hepatit....
    1. Savicka O., Zeltmatis R., Storozenko J. Molecular epidemiology of hepatitis A outbreaks and sporadic cases, Latvia, 2017 to 2019. Eurosurveillance. 2022;27:2100415. doi: 10.2807/1560-7917.ES.2022.27.11.2100415. - DOI - PMC - PubMed
    1. Bogdanić N., Bendig L., Lukas D., Zekan Š., Begovac J. Timeliness of antiretroviral therapy initiation in the era before universal treatment. Sci. Rep. 2021;11:10508. doi: 10.1038/s41598-021-90043-7. - DOI - PMC - PubMed

Publication types