澳大利亚艾滋病毒感染者中丙型肝炎病毒的控制与消除：CEASE队列的长期随访（2014 - 2023年）

Control and Elimination of Hepatitis C Virus Among People With HIV in Australia: Extended Follow-up of the CEASE Cohort (2014-2023).

作者信息

Martinello Marianne, Carson Joanne M, Post Jeffrey J, Finlayson Robert, Baker David, Read Phillip, Shaw David, Bloch Mark, Doyle Joseph, Hellard Margaret, Filep Ecaterina, Hosseini-Hooshyar Samira, Dore Gregory J, Matthews Gail V

机构信息

The Kirby Institute, University of New South Wales, Sydney, Australia.

Prince of Wales Hospital, Sydney, Australia.

出版信息

Open Forum Infect Dis. 2024 Dec 17;11(12):ofae665. doi: 10.1093/ofid/ofae665. eCollection 2024 Dec.

DOI:10.1093/ofid/ofae665

PMID:39691290

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11650530/

Abstract

BACKGROUND

Approximately 10% of people with HIV in Australia had active hepatitis C virus (HCV) infection prior to availability of government-subsidized direct-acting antiviral (DAA) therapy in 2016. This analysis evaluated progress toward HCV elimination among people with HIV in Australia between 2014 and 2023.

METHODS

The CEASE cohort study enrolled adults with HIV with past or current HCV infection (anti-HCV antibody positive) from 14 primary and tertiary clinics. Biobehavioral, clinical, and virologic data were collected at enrollment (2014-2016), follow-up 1 (2017-2018), and follow-up 2 (2021-2023). HCV treatment uptake, outcome, and HCV RNA prevalence (current infection) were evaluated. Death and HCV reinfection incidence and risk were assessed.

RESULTS

Of 402 participants, 341 (85%) had current HCV infection (RNA positive) at enrollment. Among the sample, 83% were gay and bisexual men, 13% had cirrhosis, and 80% had a history of injecting drug use (42%, past 6 months). DAA treatment was scaled up rapidly, with cumulative treatment uptake increasing from 12% in 2014 to 2015 to 92% in 2022 to 2023. HCV RNA prevalence declined from 85% (95% CI, 81%-88%) at enrollment (2014-2016) to 8% (95% CI, 6%-12%) at follow-up 1 (2017-2018) and 0.5% (95% CI, 0%-3%) at follow-up 2 (2020-2023). Sixteen reinfections occurred (incidence, 1.41 per 100 person-years; 95% CI, .81-2.29) as well as 30 deaths (incidence, 1.64 per 100 person-years; 95% CI, 1.11-2.34). HCV reinfection incidence declined over time while mortality remained stable.

CONCLUSIONS

Universal access and rapid DAA uptake were associated with a dramatic reduction in HCV prevalence and reinfection incidence among people with HIV to levels consistent with microelimination. NCT02102451 (ClinicalTrials.gov).

摘要

背景

在2016年澳大利亚政府补贴的直接抗病毒药物（DAA）疗法可用之前，约10%的澳大利亚艾滋病毒感染者患有活动性丙型肝炎病毒（HCV）感染。本分析评估了2014年至2023年澳大利亚艾滋病毒感染者在消除HCV方面取得的进展。

方法

CEASE队列研究纳入了来自14家初级和三级诊所的患有既往或当前HCV感染（抗HCV抗体阳性）的艾滋病毒成年患者。在入组时（2014 - 2016年）、随访1（2017 - 2018年）和随访2（2021 - 2023年）收集生物行为、临床和病毒学数据。评估HCV治疗的接受情况、结果以及HCV RNA流行率（当前感染情况）。评估死亡和HCV再感染的发生率及风险。

结果

402名参与者中，341名（85%）在入组时患有当前HCV感染（RNA阳性）。在该样本中，83%为男同性恋者和双性恋男性，13%患有肝硬化，80%有注射吸毒史（42%在过去6个月内有过注射吸毒）。DAA治疗迅速扩大，累积治疗接受率从2014年至2015年的12%增至2022年至2023年的92%。HCV RNA流行率从入组时（2014 - 2016年）的85%（95%CI，81% - 88%）降至随访1（2017 - 2018年）时的8%（95%CI，6% - 12%）以及随访2（2020 - 2023年）时的0.5%（95%CI，0% - 3%）。发生了十六次再感染（发生率为每100人年1.41次；95%CI，0.81 - 2.29）以及30例死亡（发生率为每100人年1.64次；95%CI，1.11 - 2.34）。HCV再感染发生率随时间下降，而死亡率保持稳定。