Hospital General Universitario Gregorio Marañón/IiSGM.
Subdirección General de Farmacia y Productos Sanitarios/SERMAS.
AIDS. 2019 Mar 15;33(4):685-689. doi: 10.1097/QAD.0000000000002103.
We analysed hepatitis C virus (HCV) reinfection among participants in a prospective registry of HIV/HCV-coinfected patients treated with all-oral direct-acting antiretroviral (DAA)-based therapy in the region of Madrid.
An observational cohort study.
The study period started on the date sustained viral response (SVR) was confirmed. The censoring date was 31 December 2017. SVR was defined as negative HCV-RNA 12 weeks after completion of treatment. Reinfection was defined as a positive HCV-RNA test result after achievement of SVR.
Reinfections were detected in 17 of 2359 HIV/HCV-coinfected patients (0.72%) overall, in 12 out of 177 (6.78%) MSM and in five out of 1459 (0.34%) people who inject drugs (PWID). The incidence of reinfection [95% confidence interval (95% CI)] per 100 person-years was 0.48 (0.30-0.77) overall, 5.93 (3.37-10.44) for MSM and 0.21 (0.09-0.52) for PWID. Reinfections were detected a median of 15 weeks (interquartile range 13-26) after SVR. In 10 (58.82%) patients, the reinfection was caused by a different HCV genotype. All 12 MSM with reinfection acknowledged unprotected anal intercourse with several partners, seven used chemsex, six reported fisting and four practiced slamming. A concomitant STI was detected in five patients. Four IDU with reinfection reported injecting drugs following SVR.
HCV reinfection is a matter of concern in HIV-positive MSM treated with all-oral DAA therapy in the region of Madrid. Our data suggest that prevention strategies and frequent testing with HCV-RNA should be applied following SVR in MSM who engage in high-risk practices.
我们分析了马德里地区接受全口服直接作用抗病毒药物（DAA）治疗的 HIV/HCV 合并感染患者前瞻性登记处中参与者的丙型肝炎病毒（HCV）再感染情况。
观察性队列研究。
研究期从获得持续病毒学应答（SVR）的日期开始。截止日期为 2017 年 12 月 31 日。SVR 定义为治疗结束后 12 周 HCV-RNA 阴性。获得 SVR 后 HCV-RNA 检测结果阳性定义为再感染。
2359 例 HIV/HCV 合并感染患者中，共有 17 例（0.72%）发生再感染，177 例男男性行为者（MSM）中 12 例（6.78%）发生再感染，1459 例静脉吸毒者（PWID）中 5 例（0.34%）发生再感染。每 100 人年的再感染发生率[95%置信区间（95%CI）]分别为 0.48（0.30-0.77）、5.93（3.37-10.44）和 0.21（0.09-0.52）。SVR 后中位时间 15 周（四分位间距 13-26）检测到再感染。10 例（58.82%）患者的再感染由不同的 HCV 基因型引起。12 例再感染的 MSM 均承认与多个伴侣发生无保护肛交，7 例有使用化学性交，6 例有报告进行肛门插入，4 例有报告进行肛交。5 例患者同时检测到性传播感染（STI）。4 例再感染的 IDU 报告在 SVR 后注射毒品。
马德里地区接受全口服 DAA 治疗的 HIV 阳性 MSM 中，HCV 再感染是一个值得关注的问题。我们的数据表明，在从事高风险行为的 MSM 获得 SVR 后，应应用预防策略和 HCV-RNA 频繁检测。
