Byrne Christopher, Robinson Emma, Rae Nikolas, Dillon John F
Molecular and Clinical Medicine University of Dundee School of Medicine Dundee UK.
Department of Gastroenterology Ninewells Hospital & Medical School Dundee UK.
Health Sci Rep. 2020 Oct 5;3(4):e191. doi: 10.1002/hsr2.191. eCollection 2020 Dec.
NHS Tayside is a health board in Scotland which serves around 400 000 residents. Approximately, 2761 are estimated to be persons who inject drugs (PWID), and therefore at risk of infections such as hepatitis C (HCV) and HIV. There are few studies exploring mechanisms and success of eliminating HCV in HIV co-infected PWID using real-world data. This study aims to empirically assess HCV treatment outcomes in people living with HIV (PLHIV) to evaluate progress toward microelimination of HCV in the HIV-positive population in Tayside.
HCV testing and treatment details for PLHIV stored on clinical databases dating from 2001 were extracted and anonymized. HCV treatment uptake among co-infected patients eligible for HCV treatment was calculated. Reinfection incidence was calculated in person years. Confidence intervals were calculated assuming Poisson distribution. Caldicott Guardian approval was obtained to access patient data (ref: IGTCAL 5677).
Ninety-six percent of PLHIV were tested for HCV across nine services and aware of their HCV status. From 2001 to 2019, 58 PLHIV were HCV co-infected. Four left the area and five died prior to HCV treatment. Forty-nine were eligible for HCV treatment. Thirty were treated with PEGylated interferon (Peg-IFN); 18 with direct acting antivirals (DAA). One is yet to be treated. Twelve treated with Peg-IFN did not achieve sustained viral response (SVR12); 10 were retreated, two died prior to re-treatment. Injecting drug use was the mode of HCV transmission for 39 of 49 patients. Proportion who achieved SVR12 is 75%; 92% if treated with DAAs. Annual proportions of PLHIV treated for HCV increased from 3.57% in the Peg-IFN era to 66.67% in the DAA era. Reinfection incidence is 0.2 per 100 person years (CI -0.3 to 0.7).
NHS Tayside has made progress toward microelimination of HCV among PLHIV. The most common mode of HCV transmission in PLHIV in NHS Tayside is injecting drug use. DAAs increased the proportion of co-infected PLHIV treated for HCV and produced superior SVR12 results compared to Peg-IFN.
泰赛德国民保健服务信托基金是苏格兰的一个卫生委员会，为约40万居民提供服务。据估计，约有2761人为注射吸毒者（PWID），因此有感染丙型肝炎（HCV）和艾滋病毒等疾病的风险。很少有研究利用实际数据探索在艾滋病毒合并感染的注射吸毒者中消除HCV的机制和成效。本研究旨在实证评估艾滋病毒感染者（PLHIV）的HCV治疗结果，以评估泰赛德艾滋病毒阳性人群在HCV微观消除方面的进展。
提取并匿名化了存储在2001年以来临床数据库中的PLHIV的HCV检测和治疗详细信息。计算了符合HCV治疗条件的合并感染患者中HCV治疗的接受率。按人年计算再感染发生率。假设为泊松分布计算置信区间。获得了考迪科特监护人的批准以获取患者数据（参考编号：IGTCAL 5677）。
在九项服务中，96%的PLHIV接受了HCV检测并知晓其HCV感染状况。2001年至2019年，58名PLHIV合并感染HCV。4人离开该地区，5人在接受HCV治疗前死亡。49人符合HCV治疗条件。30人接受了聚乙二醇干扰素（Peg - IFN）治疗；18人接受了直接抗病毒药物（DAA）治疗。1人尚未接受治疗。接受Peg - IFN治疗的12人未实现持续病毒学应答（SVR12）；10人接受了再次治疗，2人在再次治疗前死亡。49名患者中有39人的HCV传播方式为注射吸毒。实现SVR12的比例为75%；若接受DAA治疗，这一比例为92%。接受HCV治疗的PLHIV的年度比例从Peg - IFN时代的3.57%增至DAA时代的66.67%。再感染发生率为每100人年0.2（置信区间 - 0.3至0.7）。
泰赛德国民保健服务信托基金在PLHIV中HCV微观消除方面取得了进展。泰赛德国民保健服务信托基金中PLHIV最常见的HCV传播方式是注射吸毒。与Peg - IFN相比，DAA提高了合并感染HCV的PLHIV接受治疗的比例，并产生了更优的SVR12结果。
