2002-2016 年在西班牙加泰罗尼亚地区，对慢性丙型肝炎进行治疗后具有持续病毒学应答的大量囚犯队列中的再感染。
Reinfection in a large cohort of prison inmates with sustained virological response after treatment of chronic hepatitis C in Catalonia (Spain), 2002-2016.
机构信息
Prison Health Program, Catalan Institute of Health, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain.
Prison Health Program, Catalan Institute of Health, Spain.
出版信息
Int J Drug Policy. 2019 Oct;72:189-194. doi: 10.1016/j.drugpo.2019.05.014. Epub 2019 May 31.
BACKGROUND
Prisoners and other high-risk patients who show a sustained virological response (SVR) after treatment for hepatitis C virus (HCV) can become reinfected. We aimed to calculate the rate of HCV reinfection in a large cohort of inmates with SVR and to determine factors that predict reinfection.
METHODS
We included all inmates treated for hepatitis C in Catalonia (Spain) from January 2002 to December 2016 who achieved SVR and in whom viral load was subsequently determined. The incidence rate was calculated per 100 person-years (100 py) of follow up. Risk factors associated with reinfection were evaluated by bivariate log-rank test and multivariate Cox regression. Hazard ratio (HR) and their 95% confidence intervals (CI) were calculated.
RESULTS
602 patients were included, with a mean age of 37.9 years: 95% were men, 74.1% had a history of intravenous drug use (IDU) and 28.7% were HIV-infected. Patients were followed for a total of 2154.9 years (average 3.58 ± 3.1 years). 63 (10.5%) had HCV reinfection. 41 (65.1%) presented different genotype/subgenotype, 8 the initial genotype/subgenotype, and in 14 (22.2%) the genotype could not be determined. Of the 21 reinfected patients who were interviewed, 20 (95.2%) reported IDU after antiviral treatment, and 7 (33.3%) during treatment. The overall incidence of reinfection was 2.9 cases per 100 py. All reinfections occurred in patients with IDU history. At multivariate level, HIV infection was associated with reinfection (HR = 3.03; CI:1.82-5.04).
CONCLUSION
In HIV-infected inmates with IDU history, the rate of reinfection of HCV post-SVR is very high. Prisons play a key role in the detection and treatment of infection and reinfection by HCV and in the post-treatment monitoring in these patients, which should be combined with counseling and the optimization of the harm reduction programs. Effective control of these vulnerable groups favours the elimination of the HCV infection.
背景
接受丙型肝炎病毒（HCV）治疗后表现出持续病毒学应答（SVR）的囚犯和其他高危患者可能会再次感染。我们旨在计算 SVR 后大量囚犯再次感染 HCV 的比率，并确定预测再次感染的因素。
方法
我们纳入了 2002 年 1 月至 2016 年 12 月在加泰罗尼亚（西班牙）接受 HCV 治疗并随后确定病毒载量的所有达到 SVR 的囚犯。按照每 100 人年（100 py）的随访计算发病率。通过双变量对数秩检验和多变量 Cox 回归评估与再感染相关的危险因素。计算风险比（HR）及其 95%置信区间（CI）。
结果
纳入 602 例患者，平均年龄 37.9 岁：95%为男性，74.1%有静脉吸毒史（IDU），28.7%感染 HIV。患者总共随访 2154.9 年（平均 3.58±3.1 年）。63 例（10.5%）出现 HCV 再感染。41 例（65.1%）出现不同基因型/亚型，8 例为初始基因型/亚型，14 例（22.2%）无法确定基因型。21 例再感染患者中，20 例（95.2%）在抗病毒治疗后报告 IDU，7 例（33.3%）在治疗期间报告 IDU。再感染的总发病率为每 100 py 2.9 例。所有再感染均发生在有 IDU 史的患者中。在多变量水平上，HIV 感染与再感染相关（HR=3.03；95%CI：1.82-5.04）。
结论
在有 IDU 史的 HIV 感染囚犯中，SVR 后 HCV 再感染率非常高。监狱在 HCV 感染和再感染的检测和治疗以及这些患者的治疗后监测中发挥着关键作用，应与咨询和减少伤害方案的优化相结合。有效控制这些弱势群体有利于消除 HCV 感染。
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