The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
Lancet Gastroenterol Hepatol. 2021 Jan;6(1):39-56. doi: 10.1016/S2468-1253(20)30303-4. Epub 2020 Nov 18.
WHO has set targets for hepatitis C virus (HCV) elimination by 2030. We did a global systematic review of HCV prevalence and incidence in men who have sex with men (MSM) to provide updated estimates that can guide community education and public health policy.
We did a systematic review and meta-analysis of studies published and listed on MEDLINE or Embase between Jan 1, 2000, and Oct 31, 2019, including conference proceedings. Studies were eligible if they reported measures of HCV prevalence or HCV incidence (or both) among MSM. Studies that relied on participants' self-reported HCV status with no laboratory confirmation were excluded. Pooled HCV estimates in MSM were stratified by HIV status and by injecting drug use, then by WHO region and by income level. Random-effects meta-analysis was done to account for between-study heterogeneity and examined using the I statistic. Pooled HCV prevalence was also compared with HCV estimates in the general population and presented as prevalence ratios (PRs). In HIV-negative MSM, incidence estimates were stratified by use of HIV pre-exposure prophylaxis (PrEP). The systematic review was registered with PROSPERO, number CRD42020156262.
Of 1221 publications identified, 194 were deemed to be eligible and included in the systematic review and meta-analysis. Overall, the pooled HCV prevalence in MSM was 3·4% (95% CI 2·8-4·0; I=98·0%) and was highest in Africa (5·8%, 2·5-10·4) and South-East Asia (5·0%, 0·0-16·6). Globally, HCV prevalence was 1·5% (1·0-2·1) in HIV-negative MSM and 6·3% (5·3-7·5) in HIV-positive MSM. Compared with the general population, HCV prevalence was slightly higher in HIV-negative MSM (PR 1·58, 95% CI 1·14-2·01) and markedly higher (6·22, 5·14-7·29) in HIV-positive MSM. Pooled HCV prevalence was substantially higher in MSM who had ever injected drugs (30·2%, 22·0-39·0) or currently injected drugs (45·6%, 21·6-70·7) than in those who never injected drugs (2·7%, 2·0-3·6). In HIV-negative MSM, the pooled HCV incidence was 0·12 per 1000 person-years (95% CI 0·00-0·72) in individuals not on PrEP and 14·80 per 1000 person-years (9·65-20·95) in individuals on PrEP. HCV incidence in HIV-positive MSM was 8·46 per 1000 person-years (6·78-10·32).
HIV-positive MSM are at substantially increased risk of HCV. Overall, HIV-negative MSM had a slightly higher prevalence of HCV than the general population but had a lower prevalence than HIV-positive MSM. High HCV incidence in more recent PrEP studies suggests that as PrEP use increases, greater HCV transmission might occur. HCV burden in MSM varies considerably by region, which is likely to be associated with variation in the prevalence of injecting drug use and HIV.
World Health Organization.
世界卫生组织为消除丙型肝炎病毒（HCV）设定了 2030 年的目标。我们对男男性行为者（MSM）中 HCV 的流行率和发病率进行了全球系统评价，以提供可指导社区教育和公共卫生政策的最新估计值。
我们对 2000 年 1 月 1 日至 2019 年 10 月 31 日期间在 MEDLINE 或 Embase 上发表和列出的研究进行了系统评价和荟萃分析，包括会议记录。如果研究报告了 MSM 中 HCV 流行率或 HCV 发病率（或两者兼有）的衡量标准，则符合纳入标准。仅依赖参与者自我报告 HCV 状态且无实验室确认的研究被排除在外。按 HIV 状况和注射吸毒分层分析 MSM 中的 HCV 估计值，然后按世界卫生组织区域和收入水平分层。采用随机效应荟萃分析来解释研究间的异质性，并使用 I 统计量进行检查。还将 HIV 阴性 MSM 中的 HCV 流行率与一般人群中的 HCV 估计值进行了比较，并以患病率比（PR）表示。在 HIV 阴性 MSM 中，根据使用 HIV 暴露前预防（PrEP）的情况对发病率进行了分层。该系统评价已在 PROSPERO 注册，注册号为 CRD42020156262。
在确定的 1221 篇出版物中，有 194 篇被认为符合纳入标准并包含在系统评价和荟萃分析中。总体而言，MSM 中的 HCV 流行率为 3.4%（95%CI 2.8-4.0；I=98.0%），在非洲（5.8%，2.5-10.4）和东南亚（5.0%，0.0-16.6）最高。全球范围内，HIV 阴性 MSM 的 HCV 流行率为 1.5%（1.0-2.1），HIV 阳性 MSM 为 6.3%（5.3-7.5）。与一般人群相比，HIV 阴性 MSM 的 HCV 流行率略高（PR 1.58，95%CI 1.14-2.01），而 HIV 阳性 MSM 的 HCV 流行率则明显更高（6.22，5.14-7.29）。曾注射吸毒（30.2%，22.0-39.0）或目前注射吸毒（45.6%，21.6-70.7）的 MSM 比从未注射吸毒的 MSM（2.7%，2.0-3.6）的 HCV 流行率高很多。在 HIV 阴性 MSM 中，未服用 PrEP 的个体中 HCV 的年发病率为 0.12/1000 人年（95%CI 0.00-0.72），服用 PrEP 的个体中为 14.80/1000 人年（9.65-20.95）。HIV 阳性 MSM 中的 HCV 年发病率为 8.46/1000 人年（6.78-10.32）。
HIV 阳性 MSM 感染 HCV 的风险显著增加。总体而言，HIV 阴性 MSM 感染 HCV 的流行率略高于一般人群，但低于 HIV 阳性 MSM。最近的 PrEP 研究中 HCV 发病率较高表明，随着 PrEP 的使用增加，可能会发生更多的 HCV 传播。MSM 中的 HCV 负担因地区而异，这可能与注射吸毒和 HIV 的流行率有关。
世界卫生组织。
