Ma Jimmy, Nance Robin M, Cachay Edward, Ruderman Stephanie A, Kitahata Mari, Falade-Nwulia Oluwaseun, Chander Geetanjali, Drumright Lydia N, Hurt Christopher B, Yendewa George A, Pettit April, Moore Richard D, Fredericksen Rob J, Lloyd Audrey, Bamford Laura, Napravnik Sonia, Fleming Julia, Christopoulos Katerina, Burkholder Greer, Keruly Jeanne, Delaney Joseph A C, Crane Heidi, Kim H Nina
Department of Medicine, University of Washington, Seattle, Washington, USA.
Department of Medicine, University of California, San Diego, San Diego, California, USA.
Open Forum Infect Dis. 2025 Jan 17;12(2):ofaf030. doi: 10.1093/ofid/ofaf030. eCollection 2025 Feb.
National US data on the burden and risks for hepatitis C virus (HCV) infection in people with human immunodeficiency virus (HIV) during the direct-acting antiviral (DAA) era are limited. These data are important to understand current progress and guide future efforts toward HCV microelimination.
We evaluated (1) HCV prevalence (2011-2013, 2014-2017, 2018-2022) using a serial cross-sectional design and (2) correlates for HCV viremia (2018-2022) in adult people with HIV (PWH) within the Centers for AIDS Research Network of Integrated Clinic Systems (CNICS) cohort using multivariable adjusted relative risk regression. The most recent data from each time period were used for calculations and models.
In the CNICS cohort, HCV viremia prevalence was 8.7% in 2011-2013, 10.5% in 2014-2017, and 4.8% in 2018-2022. Disparities in prevalence across demographic groups defined by age, gender, and race/ethnicity were smaller in 2018-2022 than earlier time periods. In relative risk regression, female gender, detectable HIV RNA, higher proportion of missed visits (last 18 months), higher FIB-4 score, higher depressive symptom severity, and current use of methamphetamine and illicit opioids were associated with HCV viremia in 2018-2022.
The prevalence of HCV viremia during the DAA era in this US-based national cohort of PWH improved over time and across demographic subgroups but remains higher than those without HIV. Our findings highlight the continued importance of prioritizing HCV care in all PWH, especially in certain key, less-reached groups. Proactive, comprehensive efforts to care engagement, substance use, mental health, and other social determinants will be crucial to improve reach, prevention, and treatment to achieve HCV elimination goals.
在美国，关于直接作用抗病毒药物（DAA）时代人类免疫缺陷病毒（HIV）感染者丙型肝炎病毒（HCV）感染负担和风险的全国性数据有限。这些数据对于了解当前进展以及指导未来丙型肝炎微消除工作至关重要。
我们采用系列横断面设计评估了（1）HCV流行率（2011 - 2013年、2014 - 2017年、2018 - 2022年），并使用多变量调整相对风险回归评估了综合临床系统艾滋病研究网络（CNICS）队列中成年HIV感染者（PWH）的HCV病毒血症相关因素（2018 - 2022年）。每个时间段的最新数据用于计算和建模。
在CNICS队列中，2011 - 2013年HCV病毒血症流行率为8.7%，2014 - 2017年为10.5%，2018 - 2022年为4.8%。2018 - 2022年按年龄、性别和种族/族裔定义的各人口群体间的流行率差异小于早期时间段。在相对风险回归中，女性、可检测到的HIV RNA、较高的漏诊比例（过去18个月）、较高的FIB - 4评分、较高的抑郁症状严重程度以及当前使用甲基苯丙胺和非法阿片类药物与2018 - 2022年的HCV病毒血症相关。
在这个基于美国的全国性PWH队列中，DAA时代HCV病毒血症的流行率随时间推移及各人口亚组均有所改善，但仍高于未感染HIV者。我们的研究结果凸显了在所有PWH中优先进行HCV治疗的持续重要性，尤其是在某些关键的、难以触及的群体中。积极、全面地开展护理参与、物质使用、心理健康及其他社会决定因素方面的工作对于提高覆盖面、预防和治疗以实现丙型肝炎消除目标至关重要。
