aHIV Department, Chelsea and Westminster Hospital, London bSchool of Social and Community Medicine, University of Bristol, Bristol cSocial and Mathematical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK.
AIDS. 2013 Oct 23;27(16):2551-7. doi: 10.1097/QAD.0b013e32836381cc.
Liver disease secondary to hepatitis C virus (HCV) infection in the context of HIV infection is one of the leading non-AIDS causes of death. Sexual transmission of HCV infection among HIV-positive MSM appears to be leading to increased reports of acute HCV infection. Reinfection after successful treatment or spontaneous clearance is reported among HIV-positive MSM but the scale of reinfection is unknown. We calculate and compare HCV reinfection rates among HIV-positive MSM after spontaneous clearance and successful medical treatment of infection.
Retrospective analysis of HIV-positive MSM with sexually acquired HCV who subsequently spontaneously cleared or underwent successful HCV treatment between 2004 and 2012.
Among 191 individuals infected with HCV, 44 were reinfected over 562 person-years (py) of follow-up with an overall reinfection rate of 7.8/100 py [95% confidence interval (CI) 5.8-10.5]. Eight individuals were subsequently reinfected a second time at a rate of 15.5/100 py (95% CI 7.7-31.0). Combining all reinfections, 20% resulted in spontaneous clearance and treatment sustained viral response rates were 73% (16/22) for genotypes one and four and 100% (2/2) for genotypes two and three. Among 145 individuals with a documented primary infection, the reinfection rate was 8.0 per 100 py (95% CI 5.7-11.3) overall, 9.6/100 py (95% CI 6.6-14.1) among those successfully treated and 4.2/100 py (95% CI 1.7-10.0) among those who spontaneously cleared. The secondary reinfection rate was 23.2/100 py (95% CI 11.6-46.4).
Despite efforts at reducing risk behaviour, HIV-positive MSM who clear HCV infection remain at high risk of reinfection. This emphasizes the need for increased sexual education, surveillance and preventive intervention work.
在 HIV 感染的背景下，丙型肝炎病毒（HCV）感染导致的肝脏疾病是导致非艾滋病死亡的主要原因之一。HIV 阳性男男性行为者（MSM）之间性传播 HCV 感染似乎导致急性 HCV 感染报告的增加。据报道，HIV 阳性 MSM 在成功治疗或自发清除 HCV 后会再次感染，但再感染的规模尚不清楚。我们计算并比较了 HIV 阳性 MSM 在 HCV 自发清除和成功治疗后的再感染率。
对 2004 年至 2012 年间因性传播感染 HCV 后自然清除或成功接受 HCV 治疗的 HIV 阳性 MSM 进行回顾性分析。
在 191 名感染 HCV 的个体中，44 人在 562 人年（py）的随访期间再次感染，总再感染率为 7.8/100 py[95%置信区间（CI）5.8-10.5]。8 人随后再次感染，感染率为 15.5/100 py（95%CI 7.7-31.0）。将所有再感染合并，20%可自发清除，治疗持续病毒应答率为基因型 1 和 4 的 73%（16/22）和基因型 2 和 3 的 100%（2/2）。在 145 名有记录的初次感染个体中，总体再感染率为 8.0/100 py（95%CI 5.7-11.3），成功治疗者为 9.6/100 py（95%CI 6.6-14.1），自发清除者为 4.2/100 py（95%CI 1.7-10.0）。二次再感染率为 23.2/100 py（95%CI 11.6-46.4）。
尽管努力减少风险行为，但清除 HCV 感染的 HIV 阳性 MSM 仍面临较高的再感染风险。这强调了增加性教育、监测和预防干预工作的必要性。
