在西班牙安达卢西亚，实现 HIV 感染者中 HCV 微消除需要什么：建模分析。

What is needed to achieve HCV microelimination among HIV-infected populations in Andalusia, Spain: a modeling analysis.

机构信息

Division of Infectious Diseases and Global Public Health, University of California San Diego, 9500 Gilman Drive MC 0507, La Jolla, CA, 92093, USA.

Infectious Diseases Unit, Instituto Maimonides de Investigaciones Biomedicas de Cordoba (IMIBIC), Hospital Universitario Reina Sofia de Cordoba, Universidad de Cordoba, Cordoba, Spain.

出版信息

BMC Infect Dis. 2020 Aug 8;20(1):588. doi: 10.1186/s12879-020-05285-z.

DOI:10.1186/s12879-020-05285-z

PMID:32770955

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7414743/

Abstract

BACKGROUND

Scale-up of hepatitis C virus (HCV) treatment for HIV/HCV coinfected individuals is occurring in Spain, the vast majority (> 85%) with a reported history of injecting drug use and a smaller population of co-infected men who have sex with men (MSM). We assess impact of recent treatment scale-up to people living with HIV (PLWH) and implications for achieving the WHO HCV incidence elimination target (80% reduction 2015-2030) among PLWH and overall in Andalusia, Spain, using dynamic modeling.

METHODS

A dynamic transmission model of HCV/HIV coinfection was developed. The model was stratified by people who inject drugs (PWID) and MSM. The PWID component included dynamic HCV transmission from the HCV-monoinfected population. The model was calibrated to Andalusia based on published data and the HERACLES cohort (prospective cohort of HIV/HCV coinfected individuals representing > 99% coinfected individuals in care in Andalusia). From HERACLES, we incorporated HCV treatment among diagnosed PLWH of 10.5%/year from 2004 to 2014, and DAAs at 33%/year from 2015 with 94.8% SVR. We project the impact of current and scaled-up HCV treatment for PLWH on HCV prevalence and incidence among PLWH and overall.

RESULTS

Current treatment rates among PLWH (scaled-up since 2015) could substantially reduce the number of diagnosed coinfected individuals (mean 76% relative reduction from 2015 to 2030), but have little impact on new diagnosed coinfections (12% relative reduction). However, DAA scale-up to PWLH in 2015 would have minimal future impact on new diagnosed coinfections (mean 9% relative decrease from 2015 to 2030). Similarly, new cases of HCV would only reduce by a mean relative 29% among all PWID and MSM due to ongoing infection/reinfection. Diagnosing/treating all PLWH annually from 2020 would increase the number of new HCV infections among PWLH by 28% and reduce the number of new HCV infections by 39% among the broader population by 2030.

CONCLUSION

Targeted scale-up of HCV treatment to PLWH can dramatically reduce prevalence among this group but will likely have little impact on the annual number of newly diagnosed HIV/HCV coinfections. HCV microelimination efforts among PWLH in Andalusia and settings where a large proportion of PLWH have a history of injecting drug use will require scaled-up HCV diagnosis and treatment among PLWH and the broader population at risk.

摘要

背景

西班牙正在为 HIV/HCV 合并感染的个体扩大丙型肝炎病毒（HCV）治疗，其中绝大多数（>85%）有报告的注射吸毒史，还有一小部分合并感染的男男性行为者（MSM）。我们使用动态建模评估最近扩大治疗对 HIV 感染者（PLWH）的影响，并评估在西班牙安达卢西亚实现世界卫生组织 HCV 发病率消除目标（2015-2030 年减少 80%）的意义。

方法

我们建立了 HCV/HIV 合并感染的动态传播模型。该模型按注射吸毒者（PWID）和 MSM 进行分层。PWID 部分包括 HCV 从 HCV 单感染人群的动态传播。该模型基于已发表的数据和 HERACLES 队列（代表安达卢西亚接受治疗的 99%以上合并感染个体的前瞻性 HIV/HCV 合并感染个体队列）进行了校准。从 HERACLES 中，我们纳入了 2004 年至 2014 年确诊的 PLWH 中 HCV 治疗率为 10.5%/年，2015 年开始使用 DAA 治疗率为 33%/年，SVR 为 94.8%。我们预测目前和扩大规模的 PLWH HCV 治疗对 PLWH 中 HCV 流行率和发病率以及总体发病率的影响。

结果

自 2015 年以来扩大治疗的 PLWH 当前治疗率（扩大规模后）可显著减少确诊合并感染人数（2015 年至 2030 年相对减少 76%），但对新确诊合并感染的影响很小（相对减少 12%）。然而，2015 年将 DAA 扩大到 PLWH 将对新确诊的合并感染产生最小的未来影响（2015 年至 2030 年相对减少 9%）。同样，由于持续感染/再感染，所有 PWID 和 MSM 中新的 HCV 病例仅减少 29%。从 2020 年起每年对所有 PLWH 进行诊断和治疗，将使 PLWH 中的新 HCV 感染增加 28%，并使更广泛人群中的新 HCV 感染减少 39%，到 2030 年。