The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.
Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea.
HIV Med. 2022 Oct;23(9):959-968. doi: 10.1111/hiv.13280. Epub 2022 Feb 25.
Although the prevalence and mortality of hepatitis is high in the Asia-Pacific region, few studies are available on the diagnosis, treatment, and cure rates for viral hepatitis among people living with HIV in this area. This study aims to report the cascade of care (CoC) for hepatitis B (HBV) and C (HCV) among people living with HIV receiving combined antiretroviral therapy (ART).
Patients enrolled in the TREAT Asia HIV Observational Database Low Intensity Transfer (TAHOD-LITE) cohort, on ART, and with follow-up data from 2010 to 2019 were included. Patients were determined as positive for HCV or HBV co-infection if they ever tested positive for HCV antibody (anti-HCV) or HBV surface antigen (HBsAg), respectively.
In total, 39% (8612/22 340) of the adult HIV cohort had undergone HBsAg testing, with 8% (672/8612) testing positive. HBV CoC demonstrated that 71% (474/672) of those with HBsAg positive results initiated treatment, 67% (318/474) of those on treatment had HBV DNA testing to evaluate treatment progression, and 18% (58/318) of those tested reached viral suppression. Of the cohort, 37% (8231/22 340) had anti-HCV testing, of whom 10% (779/8231) tested positive. The HCV CoC showed that 68% (526/779) of those with positive anti-HCV tests had HCV RNA tests, of whom 51% (267/526) had detectable HCV RNA. Among those with detectable HCV RNA, 65% (174/267) initiated HCV treatment. Of the 40% (69/174) who initiated HCV treatment, 90% (62/69) reached sustained virological response.
Our findings identified less frequent testing in the healthcare system and limited access to treatment as gaps in the CoC for viral hepatitis. More routine HCV RNA and HBV DNA testing is required for patients with positive screening tests to identify those in need of treatment.
尽管亚太地区的肝炎发病率和死亡率较高，但针对该地区艾滋病毒感染者乙型肝炎（HBV）和丙型肝炎（HCV）的诊断、治疗和治愈率，相关研究较少。本研究旨在报告接受联合抗逆转录病毒疗法（ART）的艾滋病毒感染者的乙型肝炎（HBV）和丙型肝炎（HCV）的护理衔接情况（CoC）。
本研究纳入了 TAHOD-LITE 队列中接受 ART 治疗且 2010 年至 2019 年有随访数据的患者。如果患者曾检测出抗丙型肝炎病毒抗体（抗-HCV）或乙型肝炎表面抗原（HBsAg）阳性，则被确定为丙型肝炎或乙型肝炎合并感染。
在总共 22340 名成年艾滋病毒队列中，39%（8612 名）接受了 HBsAg 检测，其中 8%（672 名）检测结果为阳性。HBV CoC 显示，672 名 HBsAg 阳性结果患者中有 71%（474 名）开始治疗，474 名接受治疗的患者中有 67%（318 名）进行了乙型肝炎病毒 DNA 检测以评估治疗进展，18%（58 名）检测结果达到病毒抑制。在该队列中，37%（8231 名）接受了抗-HCV 检测，其中 10%（779 名）检测结果为阳性。HCV CoC 显示，779 名抗-HCV 检测阳性患者中有 68%（526 名）进行了 HCV RNA 检测，其中 51%（267 名）有可检测到的 HCV RNA。在有可检测到 HCV RNA 的患者中，65%（174 名）开始接受 HCV 治疗。在开始 HCV 治疗的 40%（69 名）患者中，90%（62 名）达到持续病毒学应答。
我们的研究结果发现，在医疗保健系统中，HBV 和 HCV 的检测频率较低，且治疗机会有限，这是病毒肝炎 CoC 中的不足之处。对于筛查检测呈阳性的患者，需要更常规地进行 HCV RNA 和 HBV DNA 检测，以确定需要治疗的患者。
