British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.
School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
Liver Int. 2021 Mar;41(3):482-493. doi: 10.1111/liv.14762. Epub 2020 Dec 22.
BACKGROUND & AIMS: Hepatitis C virus (HCV) reinfection among high-risk groups threatens HCV elimination goals. We assessed HCV reinfection rates among men who have sex with men (MSM) in British Columbia (BC), Canada.
We used data from the BC Hepatitis Testers Cohort, which includes nearly 1.7 million individuals tested for HCV or HIV in BC. MSM who had either achieved sustained virologic response (SVR) after successful HCV treatment, or spontaneous clearance (SC) and had ≥1 subsequent HCV RNA measurement, were followed from the date of SVR or SC until the earliest of reinfection, death, or last HCV RNA measurement. Predictors of reinfection were identified by Cox proportional modelling. The earliest study start date was 6 November 1997 and latest end date was 13 April 2018.
Of 1349 HCV-positive MSM who met the inclusion criteria, 493 had SC while 856 achieved SVR. 349 (25.65%) had HIV coinfection. We identified 98 reinfections during 5203 person-years (PYs) yielding a reinfection rate of 1.88/100PYs. The reinfection rate among SC (2.74/100PYs) was more than twice that of those with SVR (1.03/100 PYs). Problematic alcohol use (aHR 1.73, 95% CI 1.003-2.92), injection drug use (aHR 2.60, 95% CI 1.57-4.29) and HIV coinfection (aHR 2.04, 95% CI 1.29-3.23) were associated with increased risk of HCV reinfection. Mental health counselling history (aHR 0.24, 95% CI 0.13-0.46) was associated with reduced HCV reinfection risk.
There is the need to engage MSM in harm reduction and prevention services following treatment to reduce reinfection risk.
丙型肝炎病毒（HCV）在高危人群中的再感染威胁着 HCV 消除目标。本研究评估了加拿大不列颠哥伦比亚省（BC）男男性行为者（MSM）中的 HCV 再感染率。
我们使用了不列颠哥伦比亚省肝炎检测者队列的数据，该队列包括近 170 万在 BC 接受 HCV 或 HIV 检测的个体。对于那些成功治疗 HCV 后达到持续病毒学应答（SVR），或自发清除（SC）且随后有≥1 次 HCV RNA 检测的 MSM，从 SVR 或 SC 之日起，至再感染、死亡或最后一次 HCV RNA 检测的最早日期进行随访。采用 Cox 比例模型确定再感染的预测因素。最早的研究开始日期为 1997 年 11 月 6 日，最晚结束日期为 2018 年 4 月 13 日。
在符合纳入标准的 1349 例 HCV 阳性 MSM 中，493 例发生 SC，856 例达到 SVR。349 例（25.65%）合并 HIV 感染。在 5203 人年（PYs）中，我们共发现 98 例再感染，再感染率为 1.88/100PYs。SC 组的再感染率（2.74/100PYs）是 SVR 组（1.03/100 PYs）的两倍多。有问题的酒精使用（aHR 1.73，95%CI 1.003-2.92）、注射吸毒（aHR 2.60，95%CI 1.57-4.29）和 HIV 合并感染（aHR 2.04，95%CI 1.29-3.23）与 HCV 再感染风险增加相关。心理健康咨询史（aHR 0.24，95%CI 0.13-0.46）与 HCV 再感染风险降低相关。
需要在治疗后让 MSM 参与减少伤害和预防服务，以降低再感染风险。
