Virlogeux Victor, Zoulim Fabien, Pugliese Pascal, Poizot-Martin Isabelle, Valantin Marc-Antoine, Cuzin Lise, Reynes Jacques, Billaud Eric, Huleux Thomas, Bani-Sadr Firouze, Rey David, Frésard Anne, Jacomet Christine, Duvivier Claudine, Cheret Antoine, Hustache-Mathieu Laurent, Hoen Bruno, Cabié André, Cotte Laurent
Department of Hepatology, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France.
Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Centre de Recherche en Cancérologie de Lyon, F-69008, Lyon, France.
BMC Med. 2017 Dec 18;15(1):217. doi: 10.1186/s12916-017-0979-1.
HCV treatment uptake has drastically increased in HIV-HCV coinfected patients in France since direct-acting antiviral (DAA) treatment approval, resulting in HCV cure in 63% of all HIV-HCV patients by the end of 2015. We investigated the impact of scaling-up DAA on HCV prevalence in the whole HIV population and in various risk groups over the next 10 years in France using a transmission dynamic compartmental model.
The model was based on epidemiological data from the French Dat'AIDS cohort. Eight risk groups were considered, including high-risk (HR) and low-risk (LR) men who have sex with men (MSM) and male/female heterosexuals, intra-venous drug users, or patients from other risk groups. The model was calibrated on prevalence and incidence data observed in the cohort between 2012 and 2015.
On January 1, 2016, 156,811 patients were registered as infected with HIV in France (24,900 undiagnosed patients) of whom 7938 (5.1%) had detectable HCV-RNA (722 undiagnosed patients). Assuming a treatment coverage (TC) rate of 30%/year (i.e., the observed rate in 2015), model projections showed that HCV prevalence among HIV patients is expected to drop to 0.81% in 2026. Sub-analyses showed a similar decrease of HIV-HCV prevalence in most risk groups, including LR MSM. Due to higher infection and reinfection rates, predicted prevalence in HR MSM remained stable from 6.96% in 2016 to 6.34% in 2026. Increasing annual TC rate in HR MSM to 50/70% would decrease HCV prevalence in this group to 2.35/1.25% in 2026. With a 30% TC rate, undiagnosed patients would account for 34% of HCV infections in 2026.
Our model suggests that DAA could nearly eliminate coinfection in France within 10 years for most risk groups, including LR MSM. Elimination in HR MSM will require increased TC.
自直接抗病毒药物（DAA）获批以来，法国合并感染人类免疫缺陷病毒（HIV）和丙型肝炎病毒（HCV）的患者接受HCV治疗的比例大幅上升，截至2015年底，63%的HIV-HCV合并感染患者实现了HCV治愈。我们使用传播动力学分区模型，研究了扩大DAA治疗规模对法国未来10年整个HIV人群及不同风险组中HCV流行率的影响。
该模型基于法国艾滋病数据库队列的流行病学数据。考虑了八个风险组，包括高危（HR）和低危（LR）男男性行为者（MSM）以及男女异性恋者、静脉吸毒者或其他风险组的患者。该模型根据2012年至2015年队列中观察到的流行率和发病率数据进行校准。
2016年1月1日，法国有156,811名患者登记感染HIV（24,900名未确诊患者），其中7938名（5.1%）可检测到HCV-RNA（722名未确诊患者）。假设治疗覆盖率（TC）为每年30%（即2015年观察到的比率），模型预测显示，HIV患者中的HCV流行率预计到2026年将降至0.81%。亚分析显示，大多数风险组（包括LR MSM）中HIV-HCV的流行率也有类似下降。由于感染和再感染率较高，预计HR MSM中的流行率从2016年的6.96%稳定至2026年的6.34%。将HR MSM的年TC率提高到50/70%将使该组中的HCV流行率在2026年降至2.35/1.25%。在30%的TC率下，2026年未确诊患者将占HCV感染的34%。
我们的模型表明，对于大多数风险组，包括LR MSM，DAA可能在10年内使法国的合并感染几乎消除。HR MSM中的消除需要提高TC。
