The role for hepatitis A vaccination in HIV pre-exposure prophylaxis
Bibliographic record
Abstract
HIV pre-exposure prophylaxis (PrEP) with combined emtricitabine–tenofovir (FTC/TDF) is an effective HIV prevention modality that significantly reduces the risk for HIV acquisition [1]. Comprehensive guidelines outline how patients evaluated for PrEP should be screened and vaccinated to hepatitis B (HBV) and screened for hepatitis C (HCV); however, hepatitis A (HAV) is not mentioned in these guidelines [2]. Unfortunately, many individuals, including MSM, may be at increased risk of HAV infection. As an illustrative case, we recently cared for an individual with acute HAV infection admitted to our hospital. This 31-year-old man receives routine PrEP care in Toronto, and was sexually active with another man (source patient), who was contacted by Toronto Public Health about a potential HAV exposure at a local restaurant [3]. The source patient was hospitalized with acute HAV prior to our patient's illness. Public health officials offered vaccination for HAV postexposure prophylaxis to the source patient's roommates but not sexual contacts. Our patient suffered from nausea, vomiting, and was jaundiced. During his hospitalization, he had significant elevation in liver enzymes [aspartate aminotransferase (AST) peaking at 5771 U/l, alanine aminotransferase 2611 U/l, international normalized ratio (INR) 1.20, and bilirubin 130 μmol/l]. Serology was consistent with immunity to HBV (via vaccination), and there was no evidence of HCV or HIV acutely or at follow-up. HAV is transmitted via the fecal–oral route typically following exposure to contaminated food or water, or with sexual exposures. Infection in adulthood typically causes severe acute illness with significant morbidity and low mortality rates [4]. Outbreaks of HAV are sporadic but may affect many individuals [5], placing close contacts and sexual contacts of those exposed at risk for infection. MSM may be at increased risk of HAV infection and recently published Canadian HIV prevention guidelines recommend evaluation for HAV immunity and vaccination in nonimmune individuals [6]. Given the severity of HAV infection and efficacy of vaccination, we suggest that other PrEP guidelines recommend routine evaluation and vaccination for HAV as well. Acknowledgements Conflicts of interest There are no conflicts of interest.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.014 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.004 |
| Insufficient payload (model declined to judge) | 0.007 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".