维也纳 HIV+人群中 HCV 传播和流行的流行病学趋势。
Epidemiological trends in HCV transmission and prevalence in the Viennese HIV+ population.
机构信息
Vienna HIV & Liver Study Group, Vienna, Austria.
Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
出版信息
Liver Int. 2020 Apr;40(4):787-796. doi: 10.1111/liv.14399. Epub 2020 Mar 4.
BACKGROUND & AIMS: Human immunodeficiency virus (HIV)/hepatitis C virus (HCV) coinfection is common in people who inject drugs (PWIDs). Recently, 'high-risk' behaviour among men who have sex with men (MSM) has emerged as another main route of HCV transmission. We analysed temporal trends in HCV epidemiology in a cohort of Viennese HIV+ patients.
METHODS
Hepatitis C virus parameters were recorded at HIV diagnosis (baseline [BL]) and last visit (follow-up [FU]) for all HIV+ patients attending our HIV clinic between January 2014 and December 2016. Proportions of HIV+ patients with anti-HCV(+) and HCV viraemia (HCV-RNA(+)) at BL/FU were assessed and stratified by route of transmission.
RESULTS
In all, 1806/1874 (96.4%) HIV+ patients were tested for HCV at BL. Anti-HCV(+) was detected in 93.2% (276/296) of PWIDs and in 3.7% (31/839) of MSM. After a median FU of 6.9 years, 1644 (91.0%) patients underwent FU HCV-testing: 167 (90.3%) of PWIDs and 49 (6.7%) of MSM showed anti-HCV(+). Among 208 viraemic HCV-RNA(+) patients at BL, 30 (14.4%) had spontaneously cleared HCV, 76 (36.5%) achieved treatment-induced eradication and 89 (42.8%) remained HCV-RNA(+) at last FU. Among 1433 initially HCV-naive patients, 45 (3.5%) acquired de-novo HCV infection (11.1% PWIDs/80.0% MSM; incidence rate (IR) 0.004%; 95% confidence interval [CI] 0.0%-0.022%) and 14 had HCV reinfections (85.7% PWIDs/14.3% other; IR 0.001%; 95% CI 0.0%-0.018%) during a median FU of 6.7 years (interquartile range 7.4).
CONCLUSION
Hepatitis C virus testing was successfully implemented in the Viennese HIV(+) patients. Anti-HCV(+) prevalence remained stable in HIV+ PWIDs but almost doubled in HIV+ MSM. De-novo HCV infection occurred mostly in MSM, while HCV reinfections were mainly observed in PWIDs. HCV treatment uptake was suboptimal with 42.8% remaining HCV-RNA(+) at FU.
背景与目的
人类免疫缺陷病毒（HIV）/丙型肝炎病毒（HCV）合并感染在吸毒者（PWIDs）中很常见。最近，男男性行为者（MSM）中的“高危”行为已成为 HCV 传播的另一个主要途径。我们分析了维也纳 HIV 阳性患者队列中 HCV 流行病学的时间趋势。
方法
2014 年 1 月至 2016 年 12 月期间，在我们的 HIV 诊所就诊的所有 HIV 阳性患者在 HIV 诊断（基线[BL]）和最后一次就诊（随访[FU]）时记录 HCV 参数。根据传播途径评估 BL/FU 时 HIV 阳性患者中抗 HCV（+）和 HCV 病毒血症（HCV-RNA（+））的比例，并进行分层。
结果
共有 1874 名 HIV 阳性患者中的 1806 名在 BL 时接受了 HCV 检测。PWIDs 中检测到抗 HCV（+）的比例为 93.2%（276/296），MSM 中为 3.7%（31/839）。在中位数为 6.9 年的 FU 后，1644 名（91.0%）患者接受了 FU HCV 检测：167 名（90.3%）PWIDs 和 49 名（6.7%）MSM 显示抗 HCV（+）。在 BL 时 208 名 HCV 病毒血症 HCV-RNA（+）患者中，30 名（14.4%）自发清除了 HCV，76 名（36.5%）实现了治疗诱导的清除，89 名（42.8%）在最后一次 FU 时 HCV-RNA（+）。在 1433 名最初 HCV 阴性的患者中，45 名（3.5%）新发 HCV 感染（11.1% PWIDs/80.0% MSM；发病率（IR）0.004%；95%置信区间[CI]0.0%-0.022%），14 名有 HCV 再感染（85.7% PWIDs/14.3%其他；IR 0.001%；95%CI 0.0%-0.018%），中位 FU 为 6.7 年（四分位距 7.4）。
结论
成功地在维也纳 HIV（+）患者中实施了 HCV 检测。HIV 阳性 PWIDs 中的抗 HCV（+）患病率保持稳定，但在 HIV 阳性 MSM 中几乎翻了一番。新发 HCV 感染主要发生在 MSM 中，而 HCV 再感染主要发生在 PWIDs 中。HCV 治疗率不理想，42.8%的患者 FU 时仍存在 HCV-RNA（+）。
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