Kirby Institute for infection and immunity in society, University of New South Wales, Sydney, Australia.
Hepatology. 2012 Apr;55(4):1058-69. doi: 10.1002/hep.24754. Epub 2012 Feb 29.
The purpose of the study was to evaluate reinfection and superinfection during treatment for recent hepatitis C virus (HCV). The Australian Trial in Acute Hepatitis C (ATAHC) was a prospective study of the natural history and treatment of recent HCV. Reinfection and superinfection were defined by detection of infection with an HCV strain distinct from the primary strain (using reverse-transcription polymerase chain reaction [RT-PCR] and subtype-specific nested RT-PCR assays) in the setting of spontaneous or treatment-induced viral suppression (one HCV RNA <10 IU/mL) or persistence (HCV RNA >10 IU/mL from enrollment to week 12). Among 163 patients, 111 were treated, 79% (88 of 111) had treatment-induced viral suppression, and 60% (67 of 111) achieved sustained virological response. Following treatment-induced viral suppression, recurrence was observed in 19% (17 of 88), including 12 with relapse and five with reinfection (4.7 cases per 100 person-years [PY], 95% confidence interval [CI]: 1.9, 11.2). Among 52 untreated patients, 58% (30 of 52) had spontaneous viral suppression and recurrence was observed in 10% (3 of 30), including two with reinfection. Following reinfection, alanine aminotransferase (ALT) levels >1.5× the upper limit of normal were observed in 71% (5 of 7). Among 37 with persistence, superinfection was observed in 16% (3 of 19) of those treated and 17% (3 of 18) of those untreated. In adjusted analysis, reinfection/superinfection occurred more often in participants with poorer social functioning at enrollment and more often in those with ongoing injecting drug use (IDU).
Reinfection and superinfection can occur during treatment of recent HCV and are associated with poor social functioning and ongoing IDU. ALT levels may be a useful clinical marker of reexposure.
评估治疗近期丙型肝炎病毒（HCV）期间的再感染和重叠感染。澳大利亚急性丙型肝炎试验（ATAHC）是一项对近期 HCV 的自然史和治疗的前瞻性研究。再感染和重叠感染是指在自发或治疗诱导的病毒抑制（一种 HCV RNA<10 IU/mL）或持续（从入组到第 12 周 HCV RNA>10 IU/mL）情况下，检测到与初始株不同的 HCV 株感染（使用逆转录聚合酶链反应[RT-PCR]和亚型特异性嵌套 RT-PCR 检测）。在 163 例患者中，111 例接受了治疗，79%（88/111）患者发生了治疗诱导的病毒抑制，60%（67/111）患者获得了持续病毒学应答。在治疗诱导的病毒抑制后，88 例中有 19%（17 例）发生了复发，其中 12 例为复发，5 例为再感染（4.7 例/100 人年[PY]，95%置信区间[CI]：1.9，11.2）。在 52 例未接受治疗的患者中，58%（30 例）自发病毒抑制，10%（3 例）发生复发，其中 2 例为再感染。再感染后，71%（5 例）患者的丙氨酸氨基转移酶（ALT）水平>1.5×正常上限，在治疗组和未治疗组中分别为 17%（3 例）和 71%（3 例）。在 37 例持续感染的患者中，16%（3 例）接受治疗的患者和 17%（3 例）未接受治疗的患者发生了重叠感染。在调整分析中，在入组时社会功能较差和持续使用注射毒品（IDU）的患者中，再感染/重叠感染更常见。
在治疗近期 HCV 期间可发生再感染和重叠感染，与社会功能较差和持续使用 IDU 有关。ALT 水平可能是再暴露的有用临床标志物。
