Disease Elimination Program, Burnet Institute, Melbourne, Australia.
Department of Medicine, The University of Melbourne, Melbourne, Australia.
J Int AIDS Soc. 2018 Apr;21 Suppl 2(Suppl Suppl 2):e25051. doi: 10.1002/jia2.25051.
There is currently no published data on the effectiveness of DAA treatment for elimination of HCV infection in HIV-infected populations at a population level. However, a number of relevant studies and initiatives are emerging. This research aims to report cascade of care data for emerging HCV elimination initiatives and studies that are currently being evaluated in HIV/HCV co-infected populations in the context of implementation science theory.
HCV elimination initiatives and studies in HIV co-infected populations that are currently underway were identified. Context, intervention characteristics and cascade of care data were synthesized in the context of implementation science frameworks.
Seven HCV elimination initiatives and studies were identified in HIV co-infected populations, mainly operating in high-income countries. Four were focused mainly on HCV elimination in HIV-infected gay and bisexual men (GBM), and three included a combination of people who inject drugs (PWID), GBM and other HIV-infected populations. None were evaluating treatment delivery in incarcerated populations. Overall, HCV RNA was detected in 4894 HIV-infected participants (range within studies: 297 to 994): 48% of these initiated HCV treatment (range: 21% to 85%; within studies from a period where DAAs were broadly available the total is 57%, range: 36% to 74%). Among studies with treatment completion data, 96% of 1109 initiating treatment completed treatment (range: 94% to 99%). Among those who could be assessed for sustained virological response at 12 weeks (SVR12), 1631 of 1757 attained SVR12 (93%, range: 86% to 98%).
Early results from emerging research on HCV elimination in HIV-infected populations suggest that HCV treatment uptake is higher than reported levels prior to DAA treatment availability, but approximately half of patients remain untreated. These results are among diagnosed populations and additional effort is required to increase diagnosis rates. Among those who have initiated treatment, completion and SVR rates are promising. More data are required in order to evaluate the effectiveness of these elimination programmes in the long term, assess which intervention components are effective, and whether they need to be tailored to particular population groups.
目前，尚无关于在人群水平上，用直接作用抗病毒药物（DAA）治疗清除 HIV 感染者 HCV 感染的有效性的相关数据。但是，越来越多的相关研究正在出现。本研究旨在根据实施科学理论，报告目前正在 HIV/HCV 合并感染人群中评估的新兴 HCV 消除计划和研究的护理级联数据。
确定了目前正在进行的 HIV 合并感染人群中的 HCV 消除计划和研究。根据实施科学框架，对背景、干预措施特征和护理级联数据进行了综合分析。
在 HIV 合并感染人群中确定了 7 项 HCV 消除计划和研究，这些计划和研究主要在高收入国家开展。其中 4 项主要针对 HIV 感染的男同性恋和双性恋者（MSM）中的 HCV 消除，3 项包括了注射毒品者（IDU）、MSM 和其他 HIV 感染者。没有一项研究评估在被监禁人群中的治疗提供情况。总体而言，在 4894 名 HIV 感染者中检测到 HCV RNA（研究内范围：297 至 994）：48%的感染者启动了 HCV 治疗（范围：21%至 85%；在 DAA 广泛应用的时期内，该数字为 57%，范围：36%至 74%）。在有治疗完成数据的研究中，1109 名启动治疗者中有 96%完成了治疗（范围：94%至 99%）。在可评估 12 周持续病毒学应答（SVR12）的患者中，1757 名中的 1631 名达到了 SVR12（93%，范围：86%至 98%）。
HIV 感染者中 HCV 消除的新兴研究的早期结果表明，HCV 治疗的接受率高于 DAA 治疗前可用时报告的水平，但仍有约一半的患者未接受治疗。这些结果来自已确诊的人群，需要进一步努力提高诊断率。在已开始治疗的患者中，完成治疗和 SVR 的比例很有希望。为了评估这些消除计划的长期效果，评估哪些干预措施有效，以及它们是否需要针对特定人群进行调整，还需要更多的数据。
