Institute for Research, Quality, and Policy in Homeless Health Care, Boston Health Care for the Homeless Program, Boston, Massachusetts, USA.
The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.
Clin Infect Dis. 2023 Jul 5;77(1):46-55. doi: 10.1093/cid/ciad127.
People experiencing homelessness are disproportionately affected by hepatitis C virus (HCV) infection compared with housed populations. Surveillance for HCV reinfection after successful treatment is a critical step in the care cascade, but limited data on reinfection are available among this highly marginalized group. This study assessed posttreatment reinfection risk in a real-world cohort of homeless-experienced individuals in Boston.
Individuals receiving HCV direct-acting antiviral treatment through Boston Health Care for the Homeless Program during 2014-2020 with posttreatment follow-up assessment were included. Reinfection was identified based on recurrent HCV RNA at 12 weeks posttreatment with HCV genotype switch or any recurrent HCV RNA following sustain virologic response.
A total of 535 individuals were included (81% male, median age 49 years, 70% unstably housed or homeless at treatment initiation). Seventy-four HCV reinfections were detected, including 5 second reinfections. HCV reinfection rate was 12.0/100 person-years (95% confidence interval [CI]: 9.5-15.1) overall, 18.9/100 person-years (95% CI: 13.3-26.7) among individuals with unstable housing and 14.6/100 person-years (95% CI: 10.0-21.3) among those experiencing homelessness. In adjusted analysis, experiencing homelessness (vs stable housing, adjusted hazard ratio, 2.14; 95% CI: 1.09-4.20; P = .026) and drug use within 6 months before treatment (adjusted hazard ratio, 5.23; 95% CI: 2.25-12.13; P < .001) were associated with increased reinfection risk.
We found high HCV reinfection rates in a homeless-experienced population, with increased risk among those homeless at treatment. Tailored strategies to address the individual and systems factors impacting marginalized populations are required to prevent HCV reinfection and to enhance engagement in posttreatment HCV care.
与有住房的人群相比，无家可归者感染丙型肝炎病毒（HCV）的比例不成比例地高。成功治疗后监测 HCV 再感染是护理级联中的一个关键步骤，但在这个高度边缘化的群体中，再感染的数据有限。本研究评估了波士顿一个有过无家可归经历的人群中真实世界队列的治疗后再感染风险。
本研究纳入了 2014 年至 2020 年期间通过波士顿无家可归者医疗保健计划接受 HCV 直接作用抗病毒治疗并进行治疗后随访评估的个体。再感染是根据治疗后 12 周时 HCV RNA 复发（伴 HCV 基因型转换）或持续病毒学应答后任何 HCV RNA 复发来确定的。
共纳入 535 人（81%为男性，中位年龄 49 岁，治疗开始时 70%的人不稳定居住或无家可归）。共检测到 74 例 HCV 再感染，包括 5 例二次再感染。总的 HCV 再感染率为 12.0/100 人年（95%置信区间[CI]：9.5-15.1），不稳定居住者为 18.9/100 人年（95%CI：13.3-26.7），无家可归者为 14.6/100 人年（95%CI：10.0-21.3）。在调整分析中，无家可归（与稳定居住相比，调整后的风险比为 2.14；95%CI：1.09-4.20；P =.026）和治疗前 6 个月内的药物使用（调整后的风险比为 5.23；95%CI：2.25-12.13；P <.001）与再感染风险增加相关。
我们在一个有过无家可归经历的人群中发现了高 HCV 再感染率，并且在治疗时无家可归的人群中风险更高。需要制定针对影响边缘化人群的个体和系统因素的定制策略，以预防 HCV 再感染并加强 HCV 治疗后的治疗参与。
