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荷兰在普遍获得直接作用抗病毒药物治疗 4 年后消除 HIV 合并 HCV 感染个体：一项回顾性队列研究。

HCV micro-elimination in individuals with HIV in the Netherlands 4 years after universal access to direct-acting antivirals: a retrospective cohort study.

机构信息

Stichting HIV Monitoring, Amsterdam, Netherlands.

Stichting HIV Monitoring, Amsterdam, Netherlands; Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, Amsterdam, Netherlands.

出版信息

Lancet HIV. 2021 Feb;8(2):e96-e105. doi: 10.1016/S2352-3018(20)30301-5. Epub 2020 Dec 22.

DOI:10.1016/S2352-3018(20)30301-5

PMID:33357835

Abstract

BACKGROUND

In the Netherlands, access to direct-acting antivirals (DAAs) against hepatitis C virus (HCV) has been unrestricted for chronic infection since 2015. We evaluated whether the nationwide incidence of HCV infections in individuals with HIV has changed since 2015.

METHODS

In this retrospective cohort study, data from the ATHENA cohort of people with HIV aged 18 years or older attending any of the 24 HIV treatment centres in the Netherlands between 2000 and 2019 were assessed. We used parametric proportional hazards models with a piecewise exponential survival function to model HCV primary infection and reinfection incidence per 1000 person-years.

FINDINGS

Of the 23 590 individuals without previous HCV infection, 1269 cases of HCV primary infection were documented (incidence 5·2 per 1000 person-years [95% CI 5·0-5·5]). The highest incidence was observed in men who have sex with men (MSM; 7·7 per 1000 person-years [7·3-8·2]) and was lower in people who inject drugs (PWID; 1·7 per 1000 person-years [0·7-4·1]) and other key populations (1·0 per 1000 person-years [0·8-1·2]). In MSM, incidence increased in 2007 to 14·3 per 1000 person-years and fluctuated between 8·7 and 13·0 per 1000 person-years from 2008 to 2015. In 2016, incidence declined to 6·1 cases per 1000 person-years and remained steady between 4·1 and 4·9 per 1000 person-years from 2017 to 2019. Of the 1866 individuals with a previous HCV infection, 274 reinfections were documented (incidence 26·9 per 1000 person-years [95% CI 23·9-30·3]). The highest incidence rate was observed in MSM (38·5 per 1000 person-years [33·9-43·7]) and was lower in PWID (10·9 per 1000 person-years [3·5-33·8]) and other key populations (8·9 per 1000 person-years [6·3-12·5]). In MSM, reinfection incidence fluctuated between 38·0 and 88·9 per 1000 person-years from 2006 to 2015, reaching 55·6 per 1000 person-years in 2015. In 2016, reinfection incidence declined to 41·4 per 1000 person-years, followed by further decreases to 24·4 per 1000 person-years in 2017 and 11·4 per 1000 person-years in 2019.

INTERPRETATION

The sharp decline in HCV incidence in MSM with HIV shortly after restrictions on DAAs were lifted suggests a treatment-as-prevention effect. HCV incidence was already low in PWID and other groups before unrestricted access. Ongoing HCV transmission is occurring in MSM, as illustrated by a declining but high rate of reinfection, stressing the need for additional preventive measures.

FUNDING

Dutch Ministry of Health, Welfare, and Sport.

摘要

背景

在荷兰，自 2015 年以来，慢性 HCV 感染人群已不受限制地获得直接作用抗病毒药物（DAA）。本研究旨在评估自 2015 年以来，HIV 感染者 HCV 感染的全国发病率是否发生了变化。

方法

本回顾性队列研究纳入了 2000 年至 2019 年间在荷兰 24 个 HIV 治疗中心接受治疗的年龄≥18 岁的 HIV 感染者 ATHENA 队列中未感染 HCV 的 23590 例患者。我们使用分段指数生存函数的参数比例风险模型来计算 HCV 原发性感染和再感染的发病率（每 1000 人年发生的例数）。

结果

在 23590 例无 HCV 既往感染的患者中，共确诊了 1269 例 HCV 原发性感染（发病率为 5.2/1000 人年[95%CI 5.0-5.5]）。在 HIV 感染者中，MSM 的发病率最高（7.7/1000 人年[7.3-8.2]），而 PWID（1.7/1000 人年[0.7-4.1]）和其他重点人群（1.0/1000 人年[0.8-1.2]）的发病率较低。在 MSM 中，2007 年 HCV 发病率上升至 14.3/1000 人年，2008 年至 2015 年期间，发病率在 8.7 至 13.0/1000 人年之间波动。2016 年，发病率下降至 6.1/1000 人年，2017 年至 2019 年期间，发病率保持在 4.1 至 4.9/1000 人年之间。在 1866 例既往 HCV 感染者中，有 274 例发生再感染（发病率为 26.9/1000 人年[95%CI 23.9-30.3]）。MSM 的发病率最高（38.5/1000 人年[33.9-43.7]），PWID（10.9/1000 人年[3.5-33.8]）和其他重点人群（8.9/1000 人年[6.3-12.5]）的发病率较低。在 MSM 中，2006 年至 2015 年期间，再感染发病率在 38.0 至 88.9/1000 人年之间波动，2015 年达到 55.6/1000 人年。2016 年，再感染发病率下降至 41.4/1000 人年，随后在 2017 年进一步下降至 24.4/1000 人年，2019 年下降至 11.4/1000 人年。