Impact of HIV Pre‐Exposure Prophylaxis on HIV Incidence and Hepatitis B Outcomes Among Sex Workers Living With Hepatitis B: A Modelling Analysis in Côte D'Ivoire
11 affiliations
- 1Medical Practice Evaluation Center Massachusetts General Hospital Boston Massachusetts USA
- 2Division of Infectious Diseases Massachusetts General Hospital Boston Massachusetts USA
- 3Department of Medicine Harvard Medical School Boston Massachusetts USA
- 4Programme PAC‐CI Abidjan Côte d'Ivoire
- 5Département de Médecine et Spécialités Médicales, UFR des Sciences Médicales Université Félix Houphouët‐Boigny Abidjan Côte d'Ivoire
- 6Department of Pediatrics Harvard Medical School Boston Massachusetts USA
- 7Amsterdam Institute for Immunology and Infectious Diseases Amsterdam Netherlands
- 8Department of Infectious Diseases Public Health Service of Amsterdam Amsterdam Netherlands
- 9Department of Infectious Diseases Bern University Hospital University of Bern Bern Switzerland
- 10Division of General Internal Medicine Massachusetts General Hospital Boston Massachusetts USA
- 11Centre Population et Développement Université Paris Cité Université Sorbonne Paris Nord, IRD, Inserm Paris France
Abstract
Introduction: Nearly 10% of sex workers in sub‐Saharan Africa live with chronic hepatitis B virus (HBV). HIV pre‐exposure prophylaxis (PrEP) using tenofovir/emtricitabine (TDF/FTC) has not been studied in this population, possibly due to concerns of hepatitis flares following TDF/FTC cessation.
Methods: Using a microsimulation model of HIV and HBV disease and data from 2016 to 2024, we compared the clinical impact of TDF/FTC as PrEP versus no TDF/FTC among women who sell sex with HBV in Côte d'Ivoire. We incorporated the anti‐HBV effects of TDF/FTC and the increased probability of hepatitis flares and HBV surface antigen (HBsAg) loss following TDF/FTC cessation. We estimated input parameters from published literature: HIV incidence (1.9–3.0 per 100 person‐years), PrEP adherence (55%), disengagement from PrEP care (4% per month for the first 12 months, then 12.5% per month), hepatitis flare incidence (2.0−4.0 per 100 person‐years) and rate of HBsAg loss (1.0 per 100 person‐years), which both increase following TDF/FTC cessation. Model outcomes included cumulative HIV incidence, average hepatitis flares, HBsAg loss and survival over 2, 5 and 10 years. We conducted sensitivity analyses varying HIV incidence, PrEP adherence, disengagement from PrEP care and hepatitis flare rate.
Results: Compared with no TDF/FTC, TDF/FTC would reduce cumulative HIV incidence: 4.1% versus 5.6% at 2 years and 10.1% versus 12.7% at 5 years. TDF/FTC would result in more hepatitis flares (mean 0.76 vs. 0.19 per person) and more HBsAg loss (8.4% vs. 5.7%) than no TDF/FTC after 5 years. Two‐ and five‐year survival would be similar between the two strategies, and TDF/FTC would improve survival over longer horizons. Improving adherence and reducing disengagement from care would increase clinical benefits. Even with high disengagement from care and high risk of hepatitis flares, TDF/FTC would reduce HIV acquisition and improve overall long‐term survival.
Conclusions: Women who sell sex with HBV in Côte d'Ivoire would benefit from TDF/FTC as PrEP to avoid HIV acquisition. The increased risk of hepatitis flares, while challenging to manage in resource‐limited settings, would be outweighed by the benefits of HIV prevention. Efforts should be made to scale up PrEP in sex workers, including women with chronic HBV.
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BibTeX
@article{mohareb2026impact,
title = {{Impact of HIV Pre‐Exposure Prophylaxis on HIV Incidence and Hepatitis B Outcomes Among Sex Workers Living With Hepatitis B: A Modelling Analysis in Côte D'Ivoire}},
author = {Amir M. Mohareb and Arthur Y. Kim and Menan Gérard Kouamé and Marcellin Nouaman and Patrick A. Coffie and Maya Hajny Fernandez and Virginia R. Talbot and Ruitian Xeno Hu and Anne M. Neilan and Anders Boyd and Kenneth A. Freedberg and Joseph Larmarange and Emily P. Hyle},
journal = {Journal of the International AIDS Society},
year = {2026},
month = oct,
doi = {10.1002/jia2.70217},
url = {https://doi.org/10.1002/jia2.70217},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Impact of HIV Pre‐Exposure Prophylaxis on HIV Incidence and Hepatitis B Outcomes Among Sex Workers Living With Hepatitis B: A Modelling Analysis in Côte D'Ivoire
AU - Amir M. Mohareb
AU - Arthur Y. Kim
AU - Menan Gérard Kouamé
AU - Marcellin Nouaman
AU - Patrick A. Coffie
AU - Maya Hajny Fernandez
AU - Virginia R. Talbot
AU - Ruitian Xeno Hu
AU - Anne M. Neilan
AU - Anders Boyd
AU - Kenneth A. Freedberg
AU - Joseph Larmarange
AU - Emily P. Hyle
PY - 2026
DA - 2026/10/01
JO - Journal of the International AIDS Society
DO - 10.1002/jia2.70217
UR - https://doi.org/10.1002/jia2.70217
AB - Introduction: Nearly 10% of sex workers in sub‐Saharan Africa live with chronic hepatitis B virus (HBV). HIV pre‐exposure prophylaxis (PrEP) using tenofovir/emtricitabine (TDF/FTC) has not been studied in this population, possibly due to concerns of hepatitis flares following TDF/FTC cessation. Methods: Using a microsimulation model of HIV and HBV disease and data from 2016 to 2024, we compared the clinical impact of TDF/FTC as PrEP versus no TDF/FTC among women who sell sex with HBV in Côte d'Ivoire. We incorporated the anti‐HBV effects of TDF/FTC and the increased probability of hepatitis flares and HBV surface antigen (HBsAg) loss following TDF/FTC cessation. We estimated input parameters from published literature: HIV incidence (1.9–3.0 per 100 person‐years), PrEP adherence (55%), disengagement from PrEP care (4% per month for the first 12 months, then 12.5% per month), hepatitis flare incidence (2.0−4.0 per 100 person‐years) and rate of HBsAg loss (1.0 per 100 person‐years), which both increase following TDF/FTC cessation. Model outcomes included cumulative HIV incidence, average hepatitis flares, HBsAg loss and survival over 2, 5 and 10 years. We conducted sensitivity analyses varying HIV incidence, PrEP adherence, disengagement from PrEP care and hepatitis flare rate. Results: Compared with no TDF/FTC, TDF/FTC would reduce cumulative HIV incidence: 4.1% versus 5.6% at 2 years and 10.1% versus 12.7% at 5 years. TDF/FTC would result in more hepatitis flares (mean 0.76 vs. 0.19 per person) and more HBsAg loss (8.4% vs. 5.7%) than no TDF/FTC after 5 years. Two‐ and five‐year survival would be similar between the two strategies, and TDF/FTC would improve survival over longer horizons. Improving adherence and reducing disengagement from care would increase clinical benefits. Even with high disengagement from care and high risk of hepatitis flares, TDF/FTC would reduce HIV acquisition and improve overall long‐term survival. Conclusions: Women who sell sex with HBV in Côte d'Ivoire would benefit from TDF/FTC as PrEP to avoid HIV acquisition. The increased risk of hepatitis flares, while challenging to manage in resource‐limited settings, would be outweighed by the benefits of HIV prevention. Efforts should be made to scale up PrEP in sex workers, including women with chronic HBV.
SN - 1758-2652
ER -