Johns Hopkins University School of Medicine, Baltimore, MD.
University of California San Diego, San Diego, CA.
J Acquir Immune Defic Syndr. 2019 Apr 15;80(5):559-567. doi: 10.1097/QAI.0000000000001949.
Despite the high prevalence of hepatitis C virus (HCV) among persons living with HIV (PWH), the prevalence of HCV screening, treatment, and sustained virologic response (SVR) is unknown. This study aims to characterize the continuum of HCV screening and treatment among PWH in HIV care.
Adult patients enrolled at 12 sites of the HIV Research Network located in 3 regions of the United States were included.
We examined the prevalence of HCV screening, HCV coinfection, direct-acting antiretroviral (DAA) treatment, and SVR-12 between 2014 and 2015. Multivariate logistic regression was performed to identify characteristics associated with outcomes, adjusted for site.
Among 29,071 PWH (age 18-87, 74.8% male, 44.4% black), 77.9% were screened for HCV antibodies; 94.6% of those screened had a confirmatory HCV RNA viral load test. Among those tested, 61.1% were determined to have chronic HCV. We estimate that only 23.4% of those eligible for DAA were prescribed DAA, and only 17.8% of those eligible evidenced initiating DAA treatment. Those who initiated treatment achieved SVR-12 at a rate of 95.2%. Blacks and people who inject drugs (PWID) were more likely to be screened for HCV than whites or those with heterosexual risk. Persons older than 40 years, whites, Hispanics, and PWID [adjusted odds ratio (AOR) 8.70 (7.74 to 9.78)] were more likely to be coinfected than their counterparts. When examining treatment with DAA, persons older than 50 years, on antiretroviral therapy [AOR 2.27 (1.11 to 4.64)], with HIV-1 RNA <400 [AOR 2.67 (1.71 to 4.18)], and those with higher Fib-4 scores were more likely to be treated with DAA.
Although rates of screening for HCV among PWH are high, screening remains far from comprehensive. Rates of SVR were high, consistent with previously published literature. Additional programs to improve screening and make treatment more widely available will help reduce the impact of HCV morbidity among PWH.
尽管丙型肝炎病毒（HCV）在艾滋病毒感染者（PWH）中的流行率很高，但 HCV 筛查、治疗和持续病毒学应答（SVR）的流行率尚不清楚。本研究旨在描述 HIV 护理中 PWH 中 HCV 筛查和治疗的连续性。
本研究纳入了美国 3 个地区 12 个 HIV 研究网络地点的成年患者。
我们检查了 2014 年至 2015 年期间 HCV 筛查、HCV 合并感染、直接作用抗病毒药物（DAA）治疗和 SVR-12 的流行率。采用多变量逻辑回归分析确定与结局相关的特征，并根据地点进行调整。
在 29071 名 PWH 中（年龄 18-87 岁，74.8%为男性，44.4%为黑人），77.9%接受了 HCV 抗体筛查；筛查阳性者中有 94.6%进行了 HCV RNA 病毒载量检测。在检测人群中，61.1%确定患有慢性 HCV。我们估计，只有 23.4%符合 DAA 治疗条件的患者接受了 DAA 治疗，只有 17.8%符合 DAA 治疗条件的患者开始了 DAA 治疗。开始治疗的患者 SVR-12 率为 95.2%。黑人及静脉吸毒者（PWID）比白人或异性恋风险者更有可能接受 HCV 筛查。年龄大于 40 岁、白人、西班牙裔和 PWID[调整后的优势比（AOR）8.70（7.74 至 9.78）]更有可能发生合并感染。在检查 DAA 治疗时，年龄大于 50 岁、正在接受抗逆转录病毒治疗[AOR 2.27（1.11 至 4.64）]、HIV-1 RNA<400[AOR 2.67（1.71 至 4.18）]和 Fib-4 评分较高的患者更有可能接受 DAA 治疗。
尽管 PWH 中 HCV 筛查率很高，但筛查仍远远不够全面。SVR 率很高，与先前发表的文献一致。额外的计划，以改善筛查和使治疗更广泛地可用，将有助于减少 HCV 发病率对 PWH 的影响。
