Young Jim, Wang Shouao, Lanièce Delaunay Charlotte, Cooper Curtis L, Cox Joseph, Gill M John, Hull Mark, Walmsley Sharon, Wong Alexander, Klein Marina B
Research Institute of the McGill University Health Centre, 5252 Boulevard de Maisonneuve Ouest, Montreal, Quebec H4A3S5, Canada; Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, 2001 McGill College Suite 1200, Montreal, Quebec H3A1G1, Canada.
Research Institute of the McGill University Health Centre, 5252 Boulevard de Maisonneuve Ouest, Montreal, Quebec H4A3S5, Canada.
Int J Drug Policy. 2023 Apr;114:103981. doi: 10.1016/j.drugpo.2023.103981. Epub 2023 Mar 7.
The World Health Organisation (WHO) has set targets for the rate of new infections as a way to measure progress towards the elimination of hepatitis C virus (HCV) as a public health threat. As more people are successfully treated for HCV, a higher proportion of new infections will be reinfections. We consider whether the reinfection rate has changed since the interferon era and what we can infer about national elimination efforts from the current reinfection rate.
The Canadian Coinfection Cohort is representative of HIV HCV coinfected people in clinical care. We selected cohort participants successfully treated for a primary HCV infection either in the interferon era or in the era of direct acting antivirals (DAAs). Selected participants were followed from 12 weeks after completing a successful treatment until the end of 2019 or until their last measured HCV RNA. We estimated the reinfection rate in each treatment era, overall and in participant subgroups, using proportional hazard models appropriate for interval censored data.
Among 814 successfully treated participants with additional HCV RNA measurements, there were 62 reinfections. The overall reinfection rate was 2.6 (95% confidence interval, CI, 1.2-4.1) /100 person years (PY) in the interferon era and 3.4 (95% CI 2.5-4.4) /100 PY in the DAA era. The rate in those reporting injection drug use (IDU) was much higher: 4.7 (95% CI 1.4-7.9) /100 PY and 7.6 (95% CI 5.3-10) /100 PY in the interferon and DAA eras respectively.
The overall reinfection rate in our cohort is now above the WHO target set for new infections in people who inject drugs. The reinfection rate in those reporting IDU has increased since the interferon era. This suggests Canada is not on track to achieve HCV elimination by 2030.
世界卫生组织（WHO）已设定新感染率目标，以此衡量在消除丙型肝炎病毒（HCV）这一公共卫生威胁方面取得的进展。随着越来越多的人成功治愈HCV，新感染中再感染的比例将更高。我们探讨自干扰素时代以来再感染率是否发生了变化，以及从当前的再感染率中我们能对各国的消除努力做出何种推断。
加拿大合并感染队列代表接受临床护理的HIV-HCV合并感染人群。我们选择了在干扰素时代或直接抗病毒药物（DAA）时代成功治愈原发性HCV感染的队列参与者。选定的参与者在完成成功治疗后的12周开始随访，直至2019年底或直至其最后一次检测的HCV RNA。我们使用适合区间删失数据的比例风险模型估计每个治疗时代、总体及参与者亚组中的再感染率。
在814名成功治疗且有额外HCV RNA检测结果的参与者中，有62例再感染。干扰素时代的总体再感染率为2.6（95%置信区间，CI，1.2 - 4.1）/100人年（PY），DAA时代为3.4（95% CI 2.5 - 4.4）/100 PY。报告注射吸毒（IDU）者的再感染率更高：干扰素时代和DAA时代分别为4.7（95% CI 1.4 - 7.9）/100 PY和7.6（95% CI 5.3 - 10）/100 PY。
我们队列中的总体再感染率现已高于WHO为注射吸毒者设定的新感染目标。自干扰素时代以来，报告IDU者的再感染率有所上升。这表明加拿大在2030年实现消除HCV方面未步入正轨。
