St Vincent's Clinical School, Faculty of Medicine.
Department of Gastroenterology, St Vincent's Hospital, Sydney, New South Wales, Australia.
Curr Opin Infect Dis. 2019 Feb;32(1):31-37. doi: 10.1097/QCO.0000000000000515.
The scale-up of direct-acting antiviral (DAA) therapy and introduction of preexposure prophylaxis (PrEP) has changed the epidemiology of sexually acquired hepatitis C virus (HCV) amongst HIV-positive and HIV-negative MSM.
Sexually acquired HCV continues to occur predominantly amongst HIV-positive MSM. Despite an increased uptake of DAA therapy the incidence of acute HCV has not declined consistently amongst HIV-positive MSM, likely a result of high infection and reinfection rates. Increasing cases of sexually acquired HCV have been reported amongst HIV-negative MSM accessing PrEP. Despite a lower prevalence of HCV at baseline, HIV-negative MSM accessing PrEP have an equally high overall incidence of HCV compared with HIV-positive MSM during follow-up. Behavioural factors (high-risk sexual behaviours and sexualized drug use) appear to be driving this HCV epidemic amongst MSM and effective behavioural interventions and early identification of reinfections are essential to control the HCV epidemic amongst MSM.
An improved understanding of the epidemiology of sexually acquired HCV will allow implementation of more effective public health interventions to control the transmission of HCV amongst HIV-positive and HIV-negative MSM.
直接作用抗病毒（DAA）治疗的推广和暴露前预防（PrEP）的引入改变了 HIV 阳性和 HIV 阴性男男性行为者（MSM）中经性传播丙型肝炎病毒（HCV）的流行病学。
性传播 HCV 仍然主要发生在 HIV 阳性 MSM 中。尽管 DAA 治疗的使用率有所增加，但 HIV 阳性 MSM 中的急性 HCV 发病率并未持续下降，这可能是由于感染和再感染率较高所致。接受 PrEP 的 HIV 阴性 MSM 中报告了越来越多的性传播 HCV 病例。尽管基线 HCV 的患病率较低，但在随访期间，接受 PrEP 的 HIV 阴性 MSM 的 HCV 总发病率与 HIV 阳性 MSM 相同。行为因素（高危性行为和性化药物使用）似乎正在推动 MSM 中的 HCV 流行，有效的行为干预和早期发现再感染对于控制 MSM 中的 HCV 流行至关重要。
对性传播 HCV 的流行病学的深入了解将有助于实施更有效的公共卫生干预措施，以控制 HIV 阳性和 HIV 阴性 MSM 中 HCV 的传播。
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