Infectious Diseases Department Virology Department, APHP-Saint Louis Hospital, Paris INSERM SC10-US19, Villejuif Infectious Diseases Department, Hospices Civils de Lyon, Lyon, France Université de Montréal, Montreal, Québec, Canada Infectious Diseases Department, APHP-Tenon Hospital, Paris Infectious Diseases Department, CHU Hôtel Dieu and INSERM UIC 1413, Nantes University, Nantes Infectious Diseases Department, CHU Nice, Nice Université Paris Sud U944 INSERM, CNRS UMR 7212 Cell Biology of Virus Infection, Institut de Recherche Saint Louis, Université de Paris, Hôpital Saint-Louis, Paris, France.
AIDS. 2020 Jan 1;34(1):47-52. doi: 10.1097/QAD.0000000000002364.
A high incidence of acute hepatitis C virus (HCV) (AHCV) infection has been reported among at-risk HIV-negative MSM. The optimal strategy for early diagnosis of AHCV in this population is not clearly defined.
In the ANRS IPERGAY PrEP trial, among high-risk HIV-negative MSM, HCV serology and serum alanine aminotransferase (ALT) were used for screening at enrollment and during follow-up. Behavioral risk factors were compared at baseline between participants who were diagnosed with AHCV during the study compared with those who did not. In participants with a positive HCV serology, we used stored sera to perform the following tests at diagnosis and on previous visits: HCV-antibodies rapid tests, plasma HCV viral load and HCV antigen immunoassay. We evaluated the sensitivity of each test for AHCV diagnosis.
Among 429 enrolled participants, 14 were diagnosed with AHCV infection, with a median follow-up of 2.1 (interquartile range, 1.5-2.8) years. AHCV incidence was 1.40 per 100 person-years (95% confidence interval, 0.74-2.39). Patients with AHCV reported a significantly higher number of sexual acts and/or partners, and more frequent recreational drug use at baseline. At the prior visit before AHCV diagnosis (median of 2 months earlier), sensitivities of HCV RNA and HCV antigen tests were, respectively, 100 and 89%, whereas none of the patients had a positive serology, and only 25% had elevated ALT.
HCV antigen and RNA tests were positive within a median of 2 months before the detection of antibodies and ALT elevation. These tests could be considered for HCV screening in high-risk MSM.
在有感染风险的 HIV 阴性男男性行为者（MSM）中，急性丙型肝炎病毒（HCV）（AHCV）感染的发生率较高。在该人群中，早期诊断 AHCV 的最佳策略尚不清楚。
在 ANRS IPERGAY PrEP 试验中，在高危 HIV 阴性 MSM 中，在入组时和随访期间使用 HCV 血清学和血清丙氨酸氨基转移酶（ALT）进行筛查。在研究期间，将基线时诊断为 AHCV 的参与者与未诊断为 AHCV 的参与者进行比较，比较其行为风险因素。对于 HCV 血清学阳性的参与者，我们使用储存的血清在诊断时和之前的就诊时进行以下检查：HCV 抗体快速检测、血浆 HCV 病毒载量和 HCV 抗原免疫测定。我们评估了每种检测方法对 AHCV 诊断的敏感性。
在 429 名入组参与者中，有 14 名被诊断为 AHCV 感染，中位随访时间为 2.1 年（四分位距，1.5-2.8）。AHCV 的发病率为每 100 人年 1.40 例（95%置信区间，0.74-2.39）。AHCV 患者在基线时报告的性行为和/或性伴侣数量明显更多，且更频繁地使用娱乐性药物。在 AHCV 诊断前的前一次就诊（中位时间早 2 个月）时，HCV RNA 和 HCV 抗原检测的敏感性分别为 100%和 89%，而无患者的血清学检测呈阳性，只有 25%的患者 ALT 升高。
在检测到抗体和 ALT 升高前的中位时间为 2 个月内，HCV 抗原和 RNA 检测呈阳性。这些检测方法可考虑用于高危 MSM 的 HCV 筛查。
