Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Division, UK Health Security Agency (UKHSA), London, UK.
National Institute for Health and Care Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College London in partnership with UKHSA, London, UK.
J Viral Hepat. 2023 Aug;30(8):646-655. doi: 10.1111/jvh.13835. Epub 2023 Apr 13.
England has committed to the World Health Organization target to eliminate hepatitis C virus (HCV) as a public threat by the year 2030. Given successful treatments for HCV in recent years, it is unclear whether HCV reinfection will impact England's ability to achieve HCV elimination. We aimed to estimate the HCV reinfection rate among a cohort of patients receiving antiviral treatment using available surveillance data. Linkage between a treatment dataset from 2015 to 2019 and an HCV RNA testing dataset were used to identify people who experienced reinfection using three criteria. A Cox proportional hazards model was used to determine risk factors associated with HCV reinfection among a cohort who received treatment and had follow-up HCV RNA testing. The reinfection rate among those receiving HCV treatment was 7.91 per 100 person-years (PYs, 95% confidence interval (CI) 7.37-8.49) and highest among current injecting drug users (22.55 per 100 PYs, 95% CI 19.98-25.46) and people who had been in prison (20.42 per 100 PYs, 95% CI 17.21-24.24). In the adjusted model, women had a significantly reduced risk of reinfection. Being of younger age, current injecting drug users, and receipt of first treatment in prison were each significantly associated with increased risk of reinfection. Two-fifths of those with reinfection (43%, n = 329/767) were linked to treatment after reinfection, and of those starting treatment, three quarters (75%, n = 222/296) achieved a sustained virologic response. Guidance for testing groups at risk of reinfection and harm reduction strategies to minimize transmission should be implemented if England is to achieve HCV elimination targets.
英格兰承诺到 2030 年消除世界卫生组织将丙型肝炎病毒 (HCV) 作为公共威胁的目标。鉴于近年来 HCV 的治疗取得了成功，尚不清楚 HCV 的再感染是否会影响英格兰消除 HCV 的能力。我们旨在使用现有监测数据，估算接受抗病毒治疗的患者队列中的 HCV 再感染率。利用 2015 年至 2019 年的治疗数据集和 HCV RNA 检测数据集之间的联系，使用三个标准来确定经历再感染的人。使用 Cox 比例风险模型来确定在接受治疗并进行后续 HCV RNA 检测的队列中与 HCV 再感染相关的危险因素。接受 HCV 治疗的患者的再感染率为每 100 人年 7.91 例（95%置信区间 7.37-8.49），在当前注射吸毒者（22.55 例/100 人年，95%置信区间 19.98-25.46）和曾入狱者（20.42 例/100 人年，95%置信区间 17.21-24.24）中最高。在调整后的模型中，女性再感染的风险显著降低。年龄较小、当前注射吸毒者以及在监狱中接受首次治疗，与再感染风险增加显著相关。再感染患者中有五分之二（43%，n=329/767）在再感染后接受了治疗，在开始治疗的患者中，四分之三（75%，n=222/296）实现了持续病毒学应答。如果英格兰要实现 HCV 消除目标，应针对有再感染风险的人群进行检测，并实施减少伤害策略，以尽量减少传播。
