Disease Elimination Program, Burnet Institute, Melbourne, Vic., Australia.
Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Vic., Australia.
J Int AIDS Soc. 2018 Jan;21(1). doi: 10.1002/jia2.25059.
Outbreaks of hepatitis C virus (HCV) infections among HIV-positive men who have sex with men (MSM) have been observed globally. Using a multi-modelling approach we estimate the time and number of direct-acting antiviral treatment courses required to achieve an 80% reduction in HCV prevalence among HIV-positive MSM in the state of Victoria, Australia.
Three models of HCV transmission, testing and treatment among MSM were compared: a dynamic compartmental model; an agent-based model (ABM) parametrized to local surveillance and behavioural data ("ABM1"); and an ABM with a more heterogeneous population ("ABM2") to determine the influence of extreme variations in sexual risk behaviour.
Among approximately 5000 diagnosed HIV-positive MSM in Victoria, 10% are co-infected with HCV. ABM1 estimated that an 80% reduction in HCV prevalence could be achieved in 122 (inter-quartile range (IQR) 112 to 133) weeks with 523 (IQR 479 to 553) treatments if the average time from HCV diagnosis to treatment was six months. This was reduced to 77 (IQR 69 to 81) weeks if the average time between HCV diagnosis and treatment commencement was decreased to 16 weeks. Estimates were consistent across modelling approaches; however ABM2 produced fewer incident HCV cases, suggesting that treatment-as-prevention may be more effective in behaviourally heterogeneous populations.
Major reductions in HCV prevalence can be achieved among HIV-positive MSM within two years through routine HCV monitoring and prompt treatment as a part of HIV care. Compartmental models constructed with limited behavioural data are likely to produce conservative estimates compared to models of the same setting with more complex parametrizations.
在全球范围内，已观察到艾滋病毒阳性男男性行为者（MSM）中丙型肝炎病毒（HCV）感染的爆发。我们采用多模型方法，估计在澳大利亚维多利亚州艾滋病毒阳性 MSM 中，实现 HCV 流行率降低 80%所需的直接作用抗病毒治疗疗程数和时间。
比较了三种 MSM 中 HCV 传播、检测和治疗的模型：动态房室模型；基于代理的模型（ABM），参数化到当地监测和行为数据（“ABM1”）；以及具有更异质人群的 ABM（“ABM2”），以确定性行为风险行为的极端变化的影响。
在维多利亚州约 5000 名确诊的艾滋病毒阳性 MSM 中，10%同时感染 HCV。ABM1 估计，如果 HCV 诊断到治疗的平均时间为六个月，则可以在 122 （IQR 112 至 133）周内用 523 （IQR 479 至 553）次治疗实现 HCV 流行率降低 80%。如果将 HCV 诊断到治疗开始的平均时间缩短至 16 周，则这一数字将减少到 77 （IQR 69 至 81）周。所有模型方法的估计结果均一致；然而，ABM2 产生的 HCV 新发病例较少，这表明治疗作为预防在行为异质人群中可能更有效。
通过常规 HCV 监测和将治疗作为 HIV 护理的一部分，在两年内可以在艾滋病毒阳性 MSM 中实现 HCV 流行率的大幅降低。与具有更复杂参数化的相同环境模型相比，使用有限行为数据构建的房室模型可能会产生保守估计。
