Cheema Jaskaran S, Mathews William C, Wynn Adriane, Bamford Laura B, Torriani Francesca J, Hill Lucas A, Rajagopal Amutha V, Yin Jeffrey, Jain Sonia, Garfein Richard S, Cachay Edward R, Martin Natasha K
Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, USA.
Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, California, USA.
Open Forum Infect Dis. 2023 Mar 22;10(4):ofad153. doi: 10.1093/ofid/ofad153. eCollection 2023 Apr.
Rising incidence of hepatitis C virus (HCV) among people with HIV (PWH) in San Diego County (SDC) was reported. In 2018, the University of California San Diego (UCSD) launched a micro-elimination initiative among PWH, and in 2020 SDC launched an initiative to reduce HCV incidence by 80% across 2015-2030. We model the impact of observed treatment scale-up on HCV micro-elimination among PWH in SDC.
A model of HCV transmission among people who inject drugs (PWID) and men who have sex with men (MSM) was calibrated to SDC. The model was additionally stratified by age, gender, and HIV status. The model was calibrated to HCV viremia prevalence among PWH in 2010, 2018, and 2021 (42.1%, 18.5%, and 8.5%, respectively), and HCV seroprevalence among PWID aged 18-39 years, MSM, and MSM with HIV in 2015. We simulate treatment among PWH, weighted by UCSD Owen Clinic (reaching 26% of HCV-infected PWH) and non-UCSD treatment, calibrated to achieve the observed HCV viremia prevalence. We simulated HCV incidence with observed and further treatment scale-up (+/- risk reductions) among PWH.
Observed treatment scale-up from 2018 to 2021 will reduce HCV incidence among PWH in SDC from a mean of 429 infections/year in 2015 to 159 infections/year in 2030. County-wide scale-up to the maximum treatment rate achieved at UCSD Owen Clinic (in 2021) will reduce incidence by 69%, missing the 80% incidence reduction target by 2030 unless accompanied by behavioral risk reductions.
As SDC progresses toward HCV micro-elimination among PWH, a comprehensive treatment and risk reduction approach is necessary to reach 2030 targets.
据报道，圣地亚哥县（SDC）感染人类免疫缺陷病毒（HIV）的人群（PWH）中丙型肝炎病毒（HCV）的发病率呈上升趋势。2018年，加利福尼亚大学圣地亚哥分校（UCSD）在PWH中发起了一项微消除倡议，2020年SDC发起了一项倡议，目标是在2015 - 2030年期间将HCV发病率降低80%。我们对观察到的治疗扩大规模对SDC中PWH的HCV微消除的影响进行建模。
一个关于注射吸毒者（PWID）和男男性行为者（MSM）中HCV传播的模型被校准到SDC。该模型还按年龄、性别和HIV状态进行了分层。该模型根据2010年、2018年和2021年PWH中HCV病毒血症患病率（分别为42.1%、18.5%和8.5%）以及2015年18 - 39岁PWID、MSM和感染HIV的MSM中的HCV血清学患病率进行校准。我们模拟了PWH中的治疗情况，以UCSD欧文诊所（覆盖26%的HCV感染PWH）和非UCSD治疗为权重进行加权，校准以达到观察到的HCV病毒血症患病率。我们模拟了PWH中观察到的以及进一步扩大治疗规模（±风险降低）后的HCV发病率。
观察到的2018年至2021年治疗规模扩大将使SDC中PWH的HCV发病率从2015年的平均每年429例感染降至2030年的每年159例感染。全县范围内扩大到UCSD欧文诊所（2021年）达到的最大治疗率将使发病率降低69%，除非同时降低行为风险，否则到2030年将无法实现降低80%发病率的目标。
随着SDC朝着PWH中HCV微消除的目标前进，需要一种综合的治疗和降低风险方法才能实现2030年的目标。
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