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

IF 3.8 4区 医学 Q2 IMMUNOLOGY Open Forum Infectious Diseases Pub Date : 2024-12-17 eCollection Date: 2024-12-01 DOI:10.1093/ofid/ofae665
Marianne Martinello, Joanne M Carson, Jeffrey J Post, Robert Finlayson, David Baker, Phillip Read, David Shaw, Mark Bloch, Joseph Doyle, Margaret Hellard, Ecaterina Filep, Samira Hosseini-Hooshyar, Gregory J Dore, Gail V Matthews
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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. Registration: NCT02102451 (ClinicalTrials.gov).

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澳大利亚艾滋病毒感染者中丙型肝炎病毒的控制和消除:终止队列的延长随访(2014-2023)。
背景:在2016年政府补贴的直接作用抗病毒(DAA)治疗可用之前,澳大利亚约有10%的艾滋病毒感染者患有活动性丙型肝炎病毒(HCV)感染。该分析评估了2014年至2023年澳大利亚艾滋病毒感染者消除丙型肝炎病毒的进展。方法:CEASE队列研究招募了来自14个初级和三级诊所的过去或目前感染HCV的成人HIV患者(抗HCV抗体阳性)。在入组(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。评估了HCV治疗的接受情况、结果和HCV RNA流行率(当前感染)。评估死亡和丙型肝炎病毒再感染的发生率和风险。结果:402名参与者中,341名(85%)在入组时患有当前的HCV感染(RNA阳性)。样本中,83%为男同性恋和双性恋男性,13%患有肝硬化,80%有注射吸毒史(42%,过去6个月)。DAA治疗规模迅速扩大,累计治疗使用率从2014年至2015年的12%增加到2022年至2023年的92%。HCV RNA患病率从入组时(2014-2016)的85% (95% CI, 81%-88%)下降到随访1(2017-2018)的8% (95% CI, 6%-12%)和随访2(2020-2023)的0.5% (95% CI, 0%-3%)。发生16例再感染(发病率,1.41 / 100人年;95% CI, 0.81 -2.29)以及30例死亡(发病率,1.64 / 100人-年;95% ci, 1.11-2.34)。随着时间的推移,丙型肝炎病毒再感染的发生率下降,而死亡率保持稳定。结论:普遍获取和快速接受DAA与HIV感染者的HCV患病率和再感染发生率显著降低到与微消除一致的水平有关。注册:NCT02102451 (ClinicalTrials.gov)。
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来源期刊
Open Forum Infectious Diseases
Open Forum Infectious Diseases Medicine-Neurology (clinical)
CiteScore
6.70
自引率
4.80%
发文量
630
审稿时长
9 weeks
期刊介绍: Open Forum Infectious Diseases provides a global forum for the publication of clinical, translational, and basic research findings in a fully open access, online journal environment. The journal reflects the broad diversity of the field of infectious diseases, and focuses on the intersection of biomedical science and clinical practice, with a particular emphasis on knowledge that holds the potential to improve patient care in populations around the world. Fully peer-reviewed, OFID supports the international community of infectious diseases experts by providing a venue for articles that further the understanding of all aspects of infectious diseases.
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