丙型肝炎病毒再感染与再感染的自发清除——InC3研究

Hepatitis C Virus Reinfection and Spontaneous Clearance of Reinfection--the InC3 Study.

作者信息

Sacks-Davis Rachel, Grebely Jason, Dore Gregory J, Osburn William, Cox Andrea L, Rice Thomas M, Spelman Timothy, Bruneau Julie, Prins Maria, Kim Arthur Y, McGovern Barbara H, Shoukry Naglaa H, Schinkel Janke, Allen Todd M, Morris Meghan, Hajarizadeh Behzad, Maher Lisa, Lloyd Andrew R, Page Kimberly, Hellard Margaret

机构信息

Burnet Institute, Monash University, Melbourne Department of Epidemiology and Preventive Medicine, Monash University, Melbourne.

The Kirby Institute, University of New South Wales, Sydney, Australia.

出版信息

J Infect Dis. 2015 Nov 1;212(9):1407-19. doi: 10.1093/infdis/jiv220. Epub 2015 Apr 15.

DOI:10.1093/infdis/jiv220

PMID:25883387

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4601911/

Abstract

BACKGROUND

We aimed to characterize the natural history of hepatitis C virus (HCV) reinfection and spontaneous clearance following reinfection (reclearance), including predictors of HCV reclearance.

METHODS

Data were synthesized from the 9 prospective cohorts of the International Collaboration of Incident Human Immunodeficiency Virus and HCV in Injecting Cohorts study, which evaluated HCV infection outcomes among people who inject drugs. Participants with primary HCV infection were classified as having achieved viral suppression if they had negative results of at least 1 subsequent HCV RNA test. Those with positive results of an HCV RNA test following viral suppression were investigated for reinfection. Viral sequence analysis was used to identify reinfection (defined as detection of heterologous virus with no subsequent detection of the original viral strain).

RESULTS

Among 591 participants with acute primary HCV infection, 118 were investigated for reinfection. Twenty-eight participants were reinfected (12.3 cases/100 person-years; 95% confidence interval [CI], 8.5-17.8). Peak HCV RNA level was lower during reinfection than primary infection (P = .011). The proportion of individuals with reclearance 6 months after reinfection was 52% (95% CI, 33%-73%). After adjustment for study site, females with the IFNL4 (formerly IFNL3 and IL28B) rs12979860 CC genotype detected were more likely to have reclearance (hazard ratio, 4.16; 95% CI, 1.24-13.94; P = .021).

CONCLUSIONS

Sex and IFNL4 genotype are associated with spontaneous clearance after reinfection.

摘要

背景

我们旨在描述丙型肝炎病毒（HCV）再感染及再感染后自发清除（再清除）的自然史，包括HCV再清除的预测因素。

方法

数据来自注射人群中人类免疫缺陷病毒和HCV国际协作研究的9个前瞻性队列，该研究评估了注射毒品者中的HCV感染结局。原发性HCV感染的参与者如果至少1次后续HCV RNA检测结果为阴性，则被分类为实现了病毒抑制。病毒抑制后HCV RNA检测结果为阳性的参与者被调查是否再感染。病毒序列分析用于识别再感染（定义为检测到异源病毒且随后未检测到原始病毒株）。

结果

在591例急性原发性HCV感染的参与者中，118例被调查是否再感染。28例参与者发生再感染（12.3例/100人年；95%置信区间[CI]，8.5 - 17.8）。再感染期间HCV RNA峰值水平低于原发性感染（P = 0.011）。再感染6个月后再清除的个体比例为52%（95%CI，33% - 73%）。在对研究地点进行调整后，检测到IFNL4（原IFNL3和IL28B）rs12979860 CC基因型的女性更有可能发生再清除（风险比，4.16；95%CI，1.24 - 13.94；P = 0.021）。