Gogela N A, Sonderup M W, Rebe K, Chivese T, Spearman C W
Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa.
S Afr Med J. 2018 Jun 26;108(7):568-572. doi: 10.7196/SAMJ.2018.v108i7.13041.
Globally 1% of individuals are infected with hepatitis C virus (HCV). In South Africa (SA) the prevalence ranges between 0.3% and 1%, with few prospective screening data available. Similarly, local data on transmission modes of HCV are limited, but probably include parenteral routes and pre-1992 blood or blood products. The risk of heterosexual transmission of HCV is low but is increased in men who have sex with men (MSM), with co-transmission risk of both HIV and HCV.
Given few local data, we sought to better understand HCV characteristics and prevalence in two groups of HIV-infected men.
HIV-positive men in the greater Cape Town metropolitan area were recruited. Sexual orientation was self-identified and demographic and other personal data were obtained via a confidential questionnaire. Participants were screened for HCV after a blood draw. Those with positive HCV tests had further HCV RNA confirmation. Risk factors associated with HCV seropositivity were determined.
Five hundred HIV-positive men were recruited, 285 (57.0%) MSM and 215 (43.0%) non-MSM, median age 36 years (interquartile range (IQR) 20 - 64) and 37 years (IQR 21 - 56), respectively (p=NS). Overall, 3.4% (n=17) screened HCV-positive, 5.6% MSM (n=16) and 0.5% non-MSM (n=1); 82.4% were viraemic for HCV RNA. In respect of genotype distribution, 50.0% were infected with genotype 1a, 14.3% with genotype 4 and 35.7% with genotype 2. In terms of risk, MSM were more likely to have used drugs (54.4% v. 30.2%; p<0.001) and to have used all five modes of drug administration (13.0% MSM v. 0.5% non-MSM for injected drugs, 36.1% v. 2.3% for inhaled, 10.0% v. 0% for rectal, 48.1% v. 28.8% for smoked and 27.4% v. 2.3% for oral). More MSM than non-MSM (46.3% v. 16.7%) reported having sex while using recreational drugs, and similarly more MSM (21.4% v. 14%) reported having sex with a sex worker (SW). Risk factors for HCV seropositivity included drug use history (odds ratio (OR) 6.28, 95% confidence interval (CI) 1.78 - 22.12; p=0.004) and in MSM, sex with an SW (OR 5.5, 95% CI 2.06 - 14.68; p=0.001) or use of recreational drugs with sex (OR 6.88, 95% CI 2.21 - 21.44; p=0.001).
HCV prevalence in HIV-positive MSM is higher than previously appreciated or documented in SA. Risk factors include injection drug use, use of recreational drugs with sex, and sex with SWs. Targeted interventions are required to address this emerging challenge to achieve the viral hepatitis elimination ideal by 2030.
全球1%的人感染丙型肝炎病毒（HCV）。在南非，患病率在0.3%至1%之间，前瞻性筛查数据较少。同样，关于HCV传播模式的本地数据有限，但可能包括非肠道途径以及1992年前的血液或血液制品。HCV异性传播风险较低，但在男男性行为者（MSM）中风险增加，存在HIV和HCV共同传播风险。
鉴于本地数据较少，我们试图更好地了解两组HIV感染男性中的HCV特征和患病率。
招募了开普敦大都市区的HIV阳性男性。性取向由本人自报，并通过保密问卷获取人口统计学和其他个人数据。参与者抽血后进行HCV筛查。HCV检测呈阳性者需进一步进行HCV RNA确认。确定与HCV血清学阳性相关的危险因素。
招募了500名HIV阳性男性，其中285名（57.0%）为MSM，215名（43.0%）为非MSM，中位年龄分别为36岁（四分位间距（IQR）20 - 64）和37岁（IQR 21 - 56）（p=无显著性差异）。总体而言，3.4%（n=17）的人HCV筛查呈阳性，MSM中为5.6%（n=16），非MSM中为0.5%（n=1）；82.4%的人HCV RNA呈病毒血症。就基因型分布而言，50.0%感染1a基因型，14.3%感染4基因型，35.7%感染2基因型。在风险方面，MSM更有可能使用过毒品（54.4%对30.2%；p<0.001），且使用过所有五种给药方式（注射毒品方面，MSM为13.0%，非MSM为0.5%；吸入方面，36.1%对2.3%；直肠方面，10.0%对0%；吸食方面，48.1%对28.8%；口服方面，27.4%对2.3%）。报告在使用娱乐性毒品时发生性行为的MSM比非MSM更多（46.3%对16.7%），同样，报告与性工作者（SW）发生性行为的MSM也更多（21.4%对14%）。HCV血清学阳性的危险因素包括吸毒史（比值比（OR）6.28，95%置信区间（CI）1.78 - 22.12；p=0.004），在MSM中，与SW发生性行为（OR 5.5，95% CI 2.06 - 14.68；p=0.001）或在性行为时使用娱乐性毒品（OR 6.88，95% CI 2.21 - 21.44；p=0.001）。
HIV阳性MSM中的HCV患病率高于南非此前的认识或记录。危险因素包括注射吸毒、在性行为时使用娱乐性毒品以及与SW发生性行为。需要有针对性的干预措施来应对这一新兴挑战，以实现到2030年消除病毒性肝炎的理想目标。
