Moqueet Nasheed, Grewal Ramandip, Mazzulli Tony, Cooper Curtis, Gardner Sandra L, Salit Irving E, Kroch Abigail, Burchell Ann N
MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital Unity Health Toronto Toronto Ontario Canada.
Department of Microbiology Mount Sinai Hospital and University Health Network Toronto Ontario Canada.
Health Sci Rep. 2021 Sep 18;4(3):e358. doi: 10.1002/hsr2.358. eCollection 2021 Sep.
HIV-positive individuals may acquire HCV via injection drug use (IDU) and condomless anal sex. HIV care provides opportunities for HCV testing and cure with direct-acting antiviral agents (DAAs).
We analyzed data from the Ontario HIV Treatment Network Cohort Study. Among those not HCV-positive or diagnosed previously (n = 4586), we used Cox regression to test the rates of ever HCV testing (serological or RNA) in HIV care by DAA era (pre-DAA: 2000-2010; after DAA: 2011-2015) and compared the proportion diagnosed with HCV. We identified correlates of annual proportions of serological testing using Poisson generalized estimating equations.
After DAA vs pre-DAA, the hazard rate ratio (95% CI) of ever HCV testing was 1.70 (1.59, 1.81). The proportion (95% CI) tested annually increased from 9.2% (8.0%, 10.7%) in 2000 to 39.1% (37.1%, 41.1%) in 2015 ( < 0.0001). The proportion diagnosed with HCV declined by 74% pre-DAA to 11% after DAAs. Annual testing increased per calendar year (16% steeper slope after DAA vs pre-DAA) and was more common among men who have sex with men; those more educated (post-secondary vs ≤ high school); and those positive for syphilis or reporting any IDU. Annual testing decreased per decade of age and time since HIV diagnosis.
Annual HCV testing increased over time with higher testing among those reporting sexual or IDU risk factors, but fell short of clinical guidelines. Targeted interventions to boost testing may be needed to close these gaps and reach WHO 2030 HCV elimination targets.
HIV阳性个体可能通过注射吸毒（IDU）和无保护肛交感染丙型肝炎病毒（HCV）。HIV护理为使用直接抗病毒药物（DAA）进行HCV检测和治愈提供了机会。
我们分析了安大略省HIV治疗网络队列研究的数据。在那些之前未感染HCV或未被诊断出感染HCV的人群（n = 4586）中，我们使用Cox回归来检验DAA时代（DAA之前：2000 - 2010年；DAA之后：2011 - 2015年）HIV护理中HCV检测（血清学或RNA检测）的发生率，并比较HCV诊断比例。我们使用泊松广义估计方程确定血清学检测年度比例的相关因素。
与DAA之前相比，DAA之后HCV检测的风险率比（95%置信区间）为1.70（1.59，1.81）。每年接受检测的比例（95%置信区间）从2000年的9.2%（8.0%，10.7%）增加到2015年的39.1%（37.1%，41.1%）（P < 0.0001）。HCV诊断比例在DAA之前下降了74%，在DAA之后降至11%。每年的检测量逐年增加（DAA之后比DAA之前斜率陡16%），在男男性行为者中更常见；受教育程度较高者（大专及以上学历与高中及以下学历相比）；以及梅毒检测呈阳性或报告有任何注射吸毒行为者。每年的检测量随年龄每增长十岁以及自HIV诊断以来的时间而减少。
随着时间推移，每年的HCV检测量有所增加，报告有性传播或注射吸毒风险因素的人群检测率更高，但仍未达到临床指南要求。可能需要有针对性的干预措施来提高检测率，以缩小这些差距并实现世界卫生组织2030年消除HCV的目标。
