Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia.
School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Liver Int. 2024 Apr;44(4):1024-1031. doi: 10.1111/liv.15841. Epub 2024 Jan 31.
BACKGROUND: There is some concern that hepatitis C virus (HCV) reinfection might impact HCV micro-elimination efforts among gay and bisexual men (GBM) with HIV. However, there is a limited understanding of reinfection incidence in the context of unrestricted government-funded HCV treatment. We aimed to estimate HCV reinfection incidence among GBM with HIV in Australia from 2016 to 2020. METHODS: Data were from 39 clinics participating in ACCESS, a sentinel surveillance network for blood borne viruses and sexually transmissible infections across Australia. GBM with HIV who had evidence of treatment or spontaneous clearance with at least one positive HCV RNA test, a subsequent negative HCV RNA test, and at least one additional HCV RNA test between 1st January 2016 and 31st December 2020 were eligible for inclusion. A new HCV RNA positive test and/or detectable viral load was defined as a reinfection. Generalised linear modelling was used to examine trends in reinfection. RESULTS: Among 12 213 GBM with HIV who had at least one HCV test, 540 were included in the reinfection incidence analysis, of whom 38 (7%) had evidence of reinfection during the observation period. Over 1124 person-years of follow-up, the overall rate of reinfection was 3.4/100PY (95% CI 2.5-4.6). HCV reinfection incidence declined on average 30% per calendar year (Incidence Rate Ratio 0.70, 95% CI 0.54-0.91). CONCLUSION: HCV reinfection incidence has declined among GBM with HIV in Australia since government-funded unrestricted DAAs were made available. Ongoing HCV RNA testing following cure and prompt treatment for anyone newly diagnosed is warranted to sustain this.
背景：有人担心丙型肝炎病毒（HCV）再感染可能会影响到 HIV 阳性男同性恋和双性恋者（GBM）的 HCV 微清除工作。然而，在不受限制的政府资助的 HCV 治疗背景下，人们对再感染的发生率知之甚少。我们旨在估计 2016 年至 2020 年期间澳大利亚 HIV 阳性 GBM 中的 HCV 再感染发生率。
方法：数据来自参与澳大利亚血液传播病毒和性传播感染监测网络 ACCESS 的 39 个诊所。符合条件的 GBM 是指 HIV 阳性者，他们有治疗证据或自发清除的证据，至少有一次 HCV RNA 检测阳性、随后 HCV RNA 检测阴性、以及在 2016 年 1 月 1 日至 2020 年 12 月 31 日之间至少有一次额外的 HCV RNA 检测。新的 HCV RNA 阳性检测和/或可检测到的病毒载量被定义为再感染。使用广义线性模型来检查再感染趋势。
结果：在至少有一次 HCV 检测的 12213 名 HIV 阳性 GBM 中，有 540 名被纳入再感染发生率分析，其中 38 名（7%）在观察期间有再感染的证据。在超过 1124 人年的随访中，再感染的总体发生率为 3.4/100PY（95%CI 2.5-4.6）。HCV 再感染的发生率平均每年下降 30%（发病率比 0.70，95%CI 0.54-0.91）。
结论：自政府资助的无限制直接作用抗病毒药物（DAAs）可获得以来，澳大利亚 HIV 阳性 GBM 中的 HCV 再感染发生率有所下降。需要继续对治愈后的 HCV RNA 进行检测，并对新诊断的患者及时进行治疗，以维持这一趋势。
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