直接作用抗病毒药物作为预防措施对原发性丙型肝炎病毒感染发生率的影响：2010年至2019年多国队列研究结果
Treatment as prevention effect of direct-acting antivirals on primary hepatitis C virus incidence: Findings from a multinational cohort between 2010 and 2019.
作者信息
van Santen Daniela K, Sacks-Davis Rachel, Stewart Ashleigh, Boyd Anders, Young Jim, van der Valk Marc, Smit Colette, Rauch Andri, Braun Dominique L, Jarrin Inmaculada, Berenguer Juan, Lazarus Jeffrey V, Lacombe Karine, Requena Maria-Bernarda, Wittkop Linda, Leleux Olivier, Salmon Dominique, Bonnet Fabrice, Matthews Gail, Doyle Joseph S, Spelman Tim, Klein Marina B, Prins Maria, Asselin Jason, Stoové Mark A, Hellard Margaret
机构信息
Disease Elimination Program, Burnet Institute, Melbourne, Australia.
Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands.
出版信息
EClinicalMedicine. 2022 Dec 30;56:101810. doi: 10.1016/j.eclinm.2022.101810. eCollection 2023 Feb.
BACKGROUND
Broad direct-acting antiviral (DAA) access may reduce hepatitis C virus (HCV) incidence through a "treatment as prevention" (TasP) effect. We assessed changes in primary HCV incidence following DAA access among people living with HIV (PLHIV).
METHODS
We used pooled individual-level data from six cohorts from the International Collaboration on Hepatitis C Elimination in HIV Cohorts (InCHEHC). Follow-up started from the first recorded negative HCV antibody test date and ended at last negative antibody test or estimated infection date. Follow-up was restricted to 2010-2019. We used segmented Poisson regression to model trends across pre-, limited- (i.e., restrictions on access) and broad-DAA access periods.
FINDINGS
Overall, 45,942 participants had at least one HCV antibody negative result and follow-up between 2010 and 2019. We observed 2042 incident HCV infections over 248,189 person-years (PY). Pooled incidence decreased from 0.91 per 100 PY in 2015 to 0.41 per 100 PY in 2019. Compared to the average pre-DAA period incidence (0.90 per 100 PY), average incidence was similar during the limited-DAA access period (Incidence rate ratio [IRR] = 0.98; 95%CI = 0.87, 1.11), and 52% lower during the broad-DAA access period (IRR = 0.48; 95%CI = 0.42, 0.52). The average annual decline in HCV incidence was 2% in the pre-DAA period; an additional 9% annual decline in incidence was observed during the limited-DAA access period (IRR = 0.91; 95%CI = 0.82, 1.00) and a further 20% decline in the broad-DAA access period (IRR = 0.80, 95%CI = 0.73, 0.89).
INTERPRETATION
Our findings suggest that broad DAA access has a TasP effect on primary HCV incidence among PLHIV. Based on the initial years of DAA availability, the countries in the InCHEHC collaboration are on track to meet the World Health Organization's 80% HCV incidence reduction target for PLHIV by 2030.
FUNDING
This study was funded by the Australian Government National Health and Medical Research Council (Grant number GNT1132902).
背景
广泛使用直接作用抗病毒药物（DAA）可能通过“治疗即预防”（TasP）效应降低丙型肝炎病毒（HCV）发病率。我们评估了HIV感染者（PLHIV）中DAA广泛使用后原发性HCV发病率的变化。
方法
我们使用了来自国际HIV队列丙型肝炎消除协作组（InCHEHC）六个队列的汇总个体水平数据。随访从首次记录的HCV抗体检测阴性日期开始，至最后一次阴性抗体检测或估计感染日期结束。随访时间限制在2010年至2019年。我们使用分段泊松回归来模拟DAA使用前、有限使用期（即使用受限）和广泛使用期的趋势。
结果
总体而言，45942名参与者在2010年至2019年期间至少有一次HCV抗体阴性结果并接受了随访。在248189人年（PY）的随访中，我们观察到2042例新发HCV感染。汇总发病率从2015年的每100人年0.91例降至2019年的每100人年0.41例。与DAA使用前的平均发病率（每100人年0.90例）相比，有限DAA使用期的平均发病率相似（发病率比[IRR]=0.98；95%CI=0.87，1.11），而在广泛DAA使用期则降低了52%（IRR=0.48；95%CI=0.42，0.52）。在DAA使用前，HCV发病率的年均下降率为2%；在有限DAA使用期，发病率年均额外下降9%（IRR=0.91；95%CI=0.82，1.00），在广泛DAA使用期则进一步下降20%（IRR=0.80，95%CI=0.73，0.89）。
解读
我们的研究结果表明，广泛使用DAA对PLHIV的原发性HCV发病率具有TasP效应。基于DAA可用的最初几年情况，InCHEHC合作中的国家有望在2030年实现世界卫生组织将PLHIV的HCV发病率降低80%的目标。
资金来源
本研究由澳大利亚政府国家卫生与医学研究委员会资助（资助编号GNT1132902）。
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