High incidence of HCV in HIV-negative men who have sex with men using pre-exposure prophylaxis
High incidence of HCV in HIV-negative men who have sex with men using pre-exposure prophylaxis
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DOI：
10.1016/j.jhep.2019.11.022
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发表时间：
2020-05-01
影响因子：
25.7
通讯作者：
Prins, Maria
中科院分区：
文献类型：
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作者：
Hoornenborg, Elske;Coyer, Liza;Prins, Maria
背景与目的：丙型肝炎病毒（HCV）是一种在男男性行为者（MSM）中发生的性传播感染（STI）。我们评估了HCV感染率及其危险因素之间的HIV阴性MSM使用HIV暴露前预防（PrEP）。方法：阿姆斯特丹PrEP项目的参与者进行了检测HCV抗体或HCV-RNA每6个月。参与者每天使用或事件驱动的PrEP，并可以在随访期间切换方案。我们计算了总体HCV感染的发病率（IR），并分别计算了原发感染和再感染的发病率。一个单变量贝叶斯指数生存模型被用来确定与事件HCV感染的危险因素。结果：在350例共653.6人-年（PY）的受试者中，14例受试者检出15例HCV感染（IR = 2.30/100 PY）。有8例原发性感染（IR = 1.27/100 PY）和7例再感染（IR = 27.8/100 PY）。每日IR为2.71/100 PY，事件驱动PrEP使用者为1.15/100 PY。与HCV感染相关的因素是与临时性伴侣进行无安全套肛交的次数较多（每增加ln后验风险比[HR] 1.57; 95%可信区间[CrI] 1.09-2.20），肛门STI（后验HR 2.93; 95%CrI 1.24-7.13）、注射吸毒（后验HR 4.69; 95%CrI 1.61-12.09）和吸食毒品时共用吸管（后验HR 2.62; 95%CrI 1.09-6.02）。我们确定了强大的男男性接触者特异性的丙型肝炎病毒亚型1a，4d，2b和3a，其中包括男男性接触者和无HIV。结论：艾滋病毒阴性的男男性接触者使用PrEP的事件丙型肝炎病毒感染的风险，而确定的危险因素是类似的艾滋病毒阳性的男男性接触者。定期HCV检测是必要的，特别是对于那些以前的HCV感染和那些报告的风险factors.Lay摘要：我们报告说，丙型肝炎病毒感染是经常获得艾滋病毒阴性的男性与男性发生性关系（MSM）使用暴露前预防，以防止艾滋病毒感染。新的感染发生在那些报告接受肛交而不使用避孕套，有肛门性传播感染，注射毒品，并在吸食毒品时共用吸管。在使用暴露前预防的HIV阴性男性中发现的病毒在遗传上与HIV阳性男性中的病毒相似，但在其他丙型肝炎风险群体中则不同，这表明使用暴露前预防的HIV阳性MSM和HIV阴性MSM之间存在（性）传播。临床试验编号：荷兰试验注册号NTR 5411。(c)2019年欧洲肝脏研究协会。Elsevier B. V.出版，保留所有权利。
Background & Aims: HCV has emerged as a sexually transmitted infection (STI) among HIV-positive men who have sex with men (MSM). We evaluated HCV incidence and its risk factors among HIV-negative MSM using HIV pre-exposure prophylaxis (PrEP).Methods: Participants of the Amsterdam PrEP project were tested for HCV antibodies or HCV-RNA every 6 months. Participants used daily or event-driven PrEP and could switch regimens during follow-up. We calculated incidence rates (IRs) for overall HCV infection and separately for primary and re-infection. A univariable Bayesian exponential survival model was used to identify risk factors associated with incident HCV infection. The HCV NS5B gene fragment (709 bp) was sequenced and compared to HCV isolates from HIV-positive MSM and other risk groups (n = 419) using phylogenetic analysis.Results: Among 350 participants contributing 653.6 person-years (PYs), we detected 15 HCV infections in 14 participants (IR = 2.30/100PY). There were 8 primary infections (IR = 1.27/100PY) and 7 re-infections (IR = 27.8/100PY). IR was 2.71/100PY in daily and 1.15/100PY in event-driven PrEP users. Factors associated with incident HCV infection were higher number of receptive condomless anal sex acts with casual partners (posterior hazard ratio [HR] 1.57 per ln increase; 95% credibility interval [CrI] 1.09-2.20), anal STI (posterior HR 2.93; 95% CrI 1.24-7.13), injecting drug use (posterior HR 4.69; 95% CrI 1.61-12.09) and sharing straws when snorting drugs (posterior HR 2.62; 95% CrI 1.09-6.02). We identified robust MSM-specific HCV clusters of subtypes 1a, 4d, 2b and 3a, which included MSM with and without HIV.Conclusions: HIV-negative MSM using PrEP are at risk of incident HCV infection, while identified risk factors are similar to those in HIV-positive MSM. Regular HCV testing is needed, especially for those with a previous HCV infection and those reporting risk factors.Lay summary: We report that hepatitis C virus infections are frequently acquired among HIV-negative men who have sex with men (MSM) using pre-exposure prophylaxis to prevent HIV infection. New infections occurred more frequently in those reporting receptive anal sex without using condoms, having an anal sexually transmitted infection, injecting drugs, and sharing straws when snorting drugs. The viruses found in HIV-negative men using pre-exposure prophylaxis are genetically similar to those in HIV-positive men, but not in other hepatitis C risk groups, suggesting that (sexual) transmission is occurring between HIV-positive MSM and HIV-negative MSM using preexposure prophylaxis.Clinical Trial number: Dutch trial registration number NTR5411. (c) 2019 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.