Université de Paris, INSERM, IAME, Paris, France.
Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), Paris, France.
Euro Surveill. 2021 Sep;26(38). doi: 10.2807/1560-7917.ES.2021.26.38.2001321.
BackgroundDespite the availability of highly effective direct-acting antivirals (DAAs) and the expected treatment as prevention (TasP) effect, transmission of hepatitis C virus (HCV) persists in men who have sex with men (MSM) who engage in high-risk sexual behaviours.AimWe aimed to estimate the incidence of primary HCV infection among MSM living with HIV in France when DAA was readily available.MethodsWe used data from a large French hospital cohort of persons living with HIV (ANRS CO4-FHDH) prospectively collected between 2014 and 2017. HCV incidence rates were calculated using person-time methods for HCV-negative MSM at inclusion who had serological follow-up from 1 January 2014 to 31 December 2017. Sensitivity analyses were performed by varying the main assumptions to assess their impact on the results.ResultsOf 14,273 MSM living with HIV who were initially HCV-seronegative, 330 acquired HCV during follow-up over 45,866 person-years (py), resulting in an overall estimated incidence rate of 0.72/100 py (95% CI: 0.65-0.80). HCV incidence significantly decreased from 0.98/100 py (95% CI: 0.81-1.19) in 2014 to 0.45/100 py (95% CI: 0.35-0.59) in 2017 (54% decrease; 95% CI: 36-67). This trend was confirmed by most of the sensitivity analyses.ConclusionThe primary incidence of HCV was halved for MSM living with HIV between 2014 and 2017. This decrease may be related to unrestricted DAA availability in France for individuals living with HIV. Further interventions, including risk reduction, are needed to reach HCV micro-elimination in MSM living with HIV.
尽管已有高效的直接作用抗病毒药物（DAA），且预期治疗即预防（TasP）效果，男性同性性行为者（MSM）中的丙型肝炎病毒（HCV）传播仍在持续，这些人存在高危性行为。
当 DAA 广泛应用时，我们旨在估计法国 HIV 感染者中 MSM 原发性 HCV 感染的发生率。
我们使用了法国一家大型医院 HIV 感染者队列（ANRS CO4-FHDH）的前瞻性数据，该队列于 2014 年至 2017 年期间收集。对 HCV 阴性 MSM 进行 HCV 发病率的计算，这些 MSM 在纳入时为 HCV 血清学阴性，且从 2014 年 1 月 1 日至 2017 年 12 月 31 日进行了血清学随访。通过改变主要假设进行敏感性分析，以评估其对结果的影响。
在最初 HCV 血清学阴性的 14273 名 MSM 中，有 330 名在随访期间感染了 HCV，在 45866 人年中，总体估计发病率为 0.72/100 人年（95%CI：0.65-0.80）。HCV 发病率从 2014 年的 0.98/100 人年（95%CI：0.81-1.19）显著下降到 2017 年的 0.45/100 人年（95%CI：0.35-0.59）（54%下降；95%CI：36-67）。这一趋势在大多数敏感性分析中得到了证实。
2014 年至 2017 年间，HIV 感染者中 MSM 的 HCV 原发性发病率下降了一半。这种下降可能与法国 DAA 在 HIV 感染者中的广泛应用有关。为了实现 HIV 感染者中 HCV 的微观消除，需要进一步采取干预措施，包括减少风险。
