Liu Chen-Hua, Sun Hsin-Yun, Peng Cheng-Yuan, Hsieh Szu-Min, Yang Sheng-Shun, Kao Wei-Yu, Shih Yu-Lueng, Lin Chih-Lin, Liu Chun-Jen, Sheng Wang-Hui, Lo Yi-Chun, Liu Wen-Chun, Wu Jo-Hsuan, Su Tung-Hung, Tseng Tai-Chung, Chen Pei-Jer, Hung Chien-Ching, Kao Jia-Horng
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
Open Forum Infect Dis. 2022 Jul 22;9(8):ofac348. doi: 10.1093/ofid/ofac348. eCollection 2022 Aug.
Data on hepatitis C virus (HCV) reinfection in East Asian people with HIV after treatment-induced sustained virologic response (SVR) are limited.
HIV/HCV-coinfected patients in Taiwan who achieved SVR with interferon (IFN) or direct-acting antivirals (DAAs) between 2005 and 2021 underwent HCV RNA measurements at SVR and then biannually. HCV reinfection was defined as the detection of different HCV strains beyond SVR. HIV-negative, low-risk individuals with SVR served as reference patients. Crude reinfection rates and secular trends were assessed. Multivariate Cox regression analysis was performed to identify baseline factors associated with HCV reinfection.
A total of 216 HIV-positive and 1589 reference patients were recruited, with median follow-up durations of 3.0 and 6.0 years, respectively. During a total of 772 person-years of follow-up (PYFU), the HCV reinfection rate in HIV-positive patients was 4.02 per 100 PYFU (95% CI, 2.85-5.65), while the HCV reinfection rate in reference patients was 0.14 per 100 PYFU (95% CI, 0.09-0.23) during 10 862 PYFU. HIV-positive patients had a higher risk of HCV reinfection than reference patients (hazard ratio [HR], 17.63; 95% CI, 7.10-43.80; < .001). No baseline factors were predictive of HCV reinfection in HIV-positive patients. The incidence of HCV reinfection in HIV-positive patients increased after 2015, when DAAs were made available in Taiwan.
The risk of HCV reinfection remains high in HIV/HCV-coinfected patients with treatment-induced SVR. In addition to mass screening and treatment scale-up, strategies to reduce reinfection are needed for HCV microelimination in HIV-positive patients in Taiwan.
关于东亚地区接受治疗后获得持续病毒学应答（SVR）的HIV感染者丙型肝炎病毒（HCV）再感染的数据有限。
2005年至2021年期间在台湾实现SVR的HIV/HCV合并感染患者，使用干扰素（IFN）或直接抗病毒药物（DAA）治疗后，在SVR时进行HCV RNA检测，随后每半年检测一次。HCV再感染定义为在SVR后检测到不同的HCV毒株。HIV阴性、低风险且有SVR的个体作为对照患者。评估粗再感染率和长期趋势。进行多变量Cox回归分析以确定与HCV再感染相关的基线因素。
共招募了216例HIV阳性患者和1589例对照患者，中位随访时间分别为3.0年和6.0年。在总计772人年的随访（PYFU）期间，HIV阳性患者的HCV再感染率为每100 PYFU 4.02例（95%CI，2.85 - 5.65），而在10862 PYFU期间，对照患者的HCV再感染率为每100 PYFU 0.14例（95%CI，0.09 - 0.23）。HIV阳性患者的HCV再感染风险高于对照患者（风险比[HR]，17.63；95%CI，7.10 - 43.80；P <.001）。在HIV阳性患者中，没有基线因素可预测HCV再感染。2015年台湾可获得DAA后，HIV阳性患者的HCV再感染发生率有所增加。
在接受治疗后获得SVR的HIV/HCV合并感染患者中，HCV再感染风险仍然很高。除了大规模筛查和扩大治疗规模外，台湾地区需要采取减少再感染的策略以实现HIV阳性患者的HCV微消除。
