迈向澳大利亚 HIV 感染者丙型肝炎微消除：CEASE 研究。
Moving Towards Hepatitis C Microelimination Among People Living With Human Immunodeficiency Virus in Australia: The CEASE Study.
机构信息
The Kirby Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia.
St Vincent's Hospital, Sydney, New South Wales, Australia.
出版信息
Clin Infect Dis. 2020 Sep 12;71(6):1502-1510. doi: 10.1093/cid/ciz985.
BACKGROUND
Microelimination of hepatitis C virus (HCV) among people living with human immunodeficiency virus (HIV) may be feasible in Australia, given unrestricted access to direct-acting antiviral (DAA) therapy from 2016. Our aim was to evaluate progress towards elimination goals within HIV/HCV-coinfected adults in Australia following universal DAA access.
METHODS
The CEASE prospective cohort study enrolled adults with HIV/HCV, irrespective of viremic status, from 14 primary and tertiary clinics in Australia. Annual and cumulative HCV treatment uptake, outcome, and HCV RNA prevalence were evaluated, with follow-up through May 2018 (median follow-up, 2.63 years). Factors associated with DAA uptake were analyzed.
RESULTS
Between July 2014 and March 2017, 402 participants who were HIV/HCV antibody positive were enrolled (95% male [80% gay and bisexual men,], 13% cirrhosis, 80% history of injecting drug use [39% currently injecting]). Following universal DAA access, annual HCV treatment uptake in those eligible increased from 7% and 11% per year in 2014 and 2015, respectively, to 80% in 2016. By 2018, cumulative HCV treatment uptake in those ever eligible for treatment was 91% (336/371). HCV viremic prevalence declined from 82% (95% CI, 78-86%) in 2014 to 8% (95% CI, 6-12%) in 2018. Reinfection was reported in only 5 participants for a reinfection incidence of 0.81 per 100 person-years (95% CI, 0.34-1.94).
CONCLUSIONS
High uptake and effectiveness of unrestricted DAA therapy in Australia have permitted rapid treatment scale-up, with a dramatic reduction in HCV infection burden and low reinfection rate among people living with HIV, suggesting that microelimination is feasible.
CLINICAL TRIALS REGISTRATION
NCT02102451.
背景
鉴于自 2016 年以来澳大利亚已无限制地获得直接作用抗病毒（DAA）治疗，对人类免疫缺陷病毒（HIV）感染者进行丙型肝炎病毒（HCV）微消除可能是可行的。我们的目的是评估在澳大利亚 HIV/HCV 合并感染成人中，在获得普遍 DAA 治疗后，消除目标的进展情况。
方法
CEASE 前瞻性队列研究纳入了来自澳大利亚 14 个初级和三级诊所的 HIV/HCV 感染者，无论病毒载量状态如何。评估了每年和累计 HCV 治疗的参与情况、结局以及 HCV RNA 流行率，并于 2018 年 5 月进行随访（中位随访时间为 2.63 年）。分析了与 DAA 参与相关的因素。
结果
2014 年 7 月至 2017 年 3 月期间，共纳入 402 名 HIV/HCV 抗体阳性患者（95%为男性[80%为男同性恋和双性恋者]，13%患有肝硬化，80%有注射吸毒史[39%目前正在注射]）。在获得普遍 DAA 治疗后，2016 年，符合条件的患者每年 HCV 治疗参与率从 2014 年和 2015 年的 7%和 11%分别增加到 80%。到 2018 年，所有符合治疗条件的患者的 HCV 治疗累计参与率达到 91%（336/371）。2014 年 HCV 病毒血症流行率为 82%（95%可信区间，78-86%），2018 年下降至 8%（95%可信区间，6-12%）。仅报告了 5 例再感染，再感染发病率为 0.81/100人年（95%可信区间，0.34-1.94）。
结论
澳大利亚无限制 DAA 治疗的高参与率和有效性使得治疗迅速扩大规模，HCV 感染负担显著降低，HIV 感染者的再感染率低，这表明微消除是可行的。
临床试验注册
NCT02102451。
Zotero 插件