Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich.
Institute of Medical Virology, University of Zurich.
Clin Infect Dis. 2019 Feb 1;68(4):561-568. doi: 10.1093/cid/ciy545.
The proportion of undiagnosed hepatitis C virus (HCV) infections in high-risk populations, such as human immunodeficiency virus (HIV)-infected men who have sex with men (MSM) is unclear. Identification of potential HCV transmitters is important to reach World Health Organization HCV elimination targets.
Between October 2015 and May 2016, we performed a systematic HCV RNA-based screening among HIV-infected MSM participating in the Swiss HIV Cohort Study (SHCS). HCV antibodies were measured from all HCV RNA-positive samples.
Of 4257 MSM recorded in the SHCS database, we screened 3722 (87%) by HCV polymerase chain reaction, and 177 (4.8%) harbored a replicating HCV infection. We identified 24 individuals (14%) with incident HCV infection; one-third of them had a negative HCV antibody result at the time of HCV RNA positivity. In a multivariable model, elevated liver enzyme values (odds ratio, 14.52; 95% confidence interval, 9.92-21.26), unprotected sex with occasional partners (2.01; 1.36-2.98), intravenous drug use (7.13; 4.36-11.64), noninjectable drug use (1.94; 1.3-2.88), and previous syphilis diagnosis (2.56; 1.74-3.76) were associated with HCV RNA positivity.
A systematic HCV RNA-based screening among HIV-infected MSM revealed a high number of potential transmitters. A substantial subpopulation of MSM had incident infection, one-third of whom had a negative HCV antibody test result at the time of the HCV RNA positivity. These data reveal that one-time RNA testing of a high-risk population for HCV RNA might identify more infected persons than routine testing for HCV antibodies and liver enzymes.
NCT02785666.
在人类免疫缺陷病毒（HIV）感染的男男性行为者（MSM）等高危人群中，未确诊的丙型肝炎病毒（HCV）感染的比例尚不清楚。识别潜在的 HCV 传播者对于实现世界卫生组织 HCV 消除目标非常重要。
2015 年 10 月至 2016 年 5 月，我们对参加瑞士艾滋病毒队列研究（SHCS）的 HIV 感染的 MSM 进行了基于 HCV RNA 的系统筛查。对所有 HCV RNA 阳性样本均进行 HCV 抗体检测。
在 SHCS 数据库中记录的 4257 名 MSM 中，我们通过 HCV 聚合酶链反应筛查了 3722 名（87%），其中 177 名（4.8%）存在复制性 HCV 感染。我们发现 24 名（14%）个体发生了 HCV 感染；其中三分之一在 HCV RNA 阳性时 HCV 抗体结果为阴性。在多变量模型中，肝酶升高（比值比，14.52；95%置信区间，9.92-21.26）、与偶尔性伴侣发生无保护性行为（2.01；1.36-2.98）、静脉吸毒（7.13；4.36-11.64）、非注射吸毒（1.94；1.3-2.88）和既往梅毒诊断（2.56；1.74-3.76）与 HCV RNA 阳性相关。
对 HIV 感染的 MSM 进行基于 HCV RNA 的系统筛查发现了大量潜在的传播者。相当一部分 MSM 发生了感染，其中三分之一在 HCV RNA 阳性时 HCV 抗体检测结果为阴性。这些数据表明，对 HCV RNA 高危人群进行一次性 RNA 检测可能比常规 HCV 抗体和肝酶检测发现更多感染者。
NCT02785666。
