Departments of Internal Medicinea and Laboratory Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.
J Clin Microbiol. 2012 Mar;50(3):781-7. doi: 10.1128/JCM.06014-11. Epub 2011 Dec 21.
Outbreaks of sexually transmitted hepatitis C virus (HCV) infections have been recently reported in HIV-infected men who have sex with men (MSM) in Europe, Australia, and North America. Little is known concerning whether this also occurs in other Asia-Pacific countries. Between 1994 and 2010, a prospective observational cohort study was performed to assess the incidence of recent HCV seroconversion in 892 HIV-infected patients (731 MSM and 161 heterosexuals) who were not injecting drug users. A nested case-control study was conducted to identify associated factors with recent HCV seroconversion, and phylogenetic analysis was performed using NS5B sequences amplified from seroconverters. During a total followup duration of 4,270 person-years (PY), 30 patients (3.36%) had HCV seroconversion, with an overall incidence rate of 7.03 per 1,000 PY. The rate increased from 0 in 1994 to 2000 and 2.29 in 2001 to 2005 to 10.13 per 1,000 PY in 2006 to 2010 (P < 0.05). After adjustment for age and HIV transmission route, recent syphilis remained an independent factor associated with HCV seroconversion (odds ratio, 7.731; 95% confidence interval, 3.131 to 19.086; P < 0.01). In a nested case-control study, seroconverters had higher aminotranferase levels and were more likely to have CD4 ≥ 200 cells/μl and recent syphilis than nonseroconverters (P < 0.05). Among the 21 patients with HCV viremia, phylogenetic analysis revealed 7 HCV transmission clusters or pairs (4 within genotype 1b, 2 within genotype 2a, and 1 within genotype 3a). The incidence of HCV seroconversion that is associated with recent syphilis is increasing among HIV-infected patients in Taiwan.
在欧洲、澳大利亚和北美，近期有研究报道男男性行为者（MSM）中的 HIV 感染者发生了性传播丙型肝炎病毒（HCV）感染爆发。目前对于其他亚太国家是否也存在这种情况还知之甚少。1994 年至 2010 年，我们开展了一项前瞻性观察队列研究，以评估 892 名未使用注射毒品的 HIV 感染者（731 名 MSM 和 161 名异性恋者）中近期 HCV 血清转换的发生率。我们进行了一项巢式病例对照研究，以确定与近期 HCV 血清转换相关的因素，并使用从血清转换者中扩增的 NS5B 序列进行系统进化分析。在总共 4270 人年（PY）的随访期间，30 名患者（3.36%）发生了 HCV 血清转换，总发生率为 7.03/1000PY。该发生率从 1994 年至 2000 年的 0 增加到 2001 年至 2005 年的 2.29/1000PY，再增加到 2006 年至 2010 年的 10.13/1000PY（P<0.05）。调整年龄和 HIV 传播途径后，近期梅毒仍是与 HCV 血清转换相关的独立因素（比值比，7.731；95%置信区间，3.131 至 19.086；P<0.01）。在巢式病例对照研究中，血清转换者的氨基转移酶水平较高，且更有可能具有 CD4≥200 个/μl 和近期梅毒（P<0.05）。在 21 名 HCV 病毒血症患者中，系统进化分析显示有 7 个 HCV 传播簇或对（4 个属于 1b 基因型，2 个属于 2a 基因型，1 个属于 3a 基因型）。在台湾，与近期梅毒相关的 HIV 感染者中 HCV 血清转换的发生率正在增加。
