Hall Christopher S, Charlebois Edwin D, Hahn Judith A, Moss Andrew R, Bangsberg David R
Division of Infectious Diseases, San Francisco General Hospital, San Francisco, California, USA.
J Gen Intern Med. 2004 Apr;19(4):357-65. doi: 10.1111/j.1525-1497.2004.30613.x.
To measure Hepatitis C Virus (HCV) prevalence, incidence, and initiation of HCV therapy in a representative HIV-infected cohort of the urban poor.
Cohort analysis.
The Research and Access to Care for the Homeless (REACH) Cohort is a systematic sample of HIV-infected marginally housed individuals identified from single-room occupancy hotels, homeless shelters, and free lunch programs in San Francisco.
Two hundred forty-nine participants with 28.9 months (median) of follow-up were studied. Mean age was 44 (range 24 to 75, standard deviation 8.4) years. Eighty-two percent were male, 43% were African-American, 64% were lifetime injection drug users, and 24% had been on the street or in a shelter in the prior month.
We measured HCV testing and treatment history with structured interviews; additionally, participants were tested for HCV antibodies (EIA-2) with RNA viral load confirmation.
At baseline, 172 (69.1%) were HCV-positive and 182 (73.1%) were HCV-positive at follow-up, including 155 (62.2%) with viremia. HCV-positive status was associated with having injected drugs, elevated serum alanine aminotransferase, homelessness in the last 1 year, and more severe depressive symptoms. The incidence of new HCV infection was 4.63% per person-year (ppy; 95% confidence interval, 2.31 to 8.13) in the entire cohort and 16.77% ppy among injection drug users. The prevalence of HCV antibody-negative HCV-viremia was 13.2% (10/76). Nonwhites were less likely to receive HCV testing and subspecialty referral, controlled for drug use and other confounders. Sixty-eight percent (123/182) were aware treatment was available; however, only 3.8% (7/182) or 1.16% ppy received HCV treatment.
While HCV infection is common, HCV treatment is rare in the HIV-HCV coinfected urban poor. Urban poor, nonwhite individuals are less likely to receive HCV testing and subspecialty referral than their white counterparts. Antibody-negative infection may complicate screening and diagnosis in HIV-infected persons. J
在一个具有代表性的城市贫困HIV感染者队列中，测量丙型肝炎病毒（HCV）的流行率、发病率以及HCV治疗的启动情况。
队列分析。
无家可归者研究与医疗救助（REACH）队列是从旧金山的单人房间酒店、无家可归者收容所和免费午餐项目中识别出的HIV感染的边缘居住个体的系统样本。
对249名参与者进行了研究，随访时间中位数为28.9个月。平均年龄为44岁（范围24至75岁，标准差8.4）。82%为男性，43%为非裔美国人，64%为终身注射吸毒者，24%在前一个月曾流落街头或住在收容所。
我们通过结构化访谈测量HCV检测和治疗史；此外，对参与者进行HCV抗体（EIA - 2）检测并确认RNA病毒载量。
基线时，172人（69.1%）HCV呈阳性，随访时182人（73.1%）HCV呈阳性，其中155人（62.2%）存在病毒血症。HCV阳性状态与注射吸毒、血清丙氨酸氨基转移酶升高、过去1年无家可归以及更严重的抑郁症状有关。整个队列中新HCV感染的发病率为每人年4.63%（95%置信区间，2.31至8.13），注射吸毒者中为每人年16.77%。HCV抗体阴性的HCV病毒血症的患病率为13.2%（10/76）。在控制了药物使用和其他混杂因素后，非白人接受HCV检测和专科转诊的可能性较小。68%（123/182）的人知道有治疗方法；然而，只有3.8%（7/182）或每人年1.16%的人接受了HCV治疗。
虽然HCV感染很常见，但在HIV - HCV合并感染的城市贫困人口中，HCV治疗却很少见。城市贫困的非白人个体比白人个体接受HCV检测和专科转诊的可能性更小。抗体阴性感染可能会使HIV感染者的筛查和诊断复杂化。
