Impact of test-and-treat and risk reduction strategies on HCV transmission among MSM living with HIV in France: a modelling approach
Impact of test-and-treat and risk reduction strategies on HCV transmission among MSM living with HIV in France: a modelling approach
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DOI：
10.1136/gutjnl-2020-321744
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发表时间：
2021-08-01
期刊：
影响因子：
24.5
通讯作者：
Deuffic-Burban, Sylvie
中科院分区：
文献类型：
--
作者：
Castry, Mathieu;Cousien, Anthony;Deuffic-Burban, Sylvie
目的 自 2000 年代初以来，HCV 在感染 HIV 的男男性接触者（MSM）中流行，主要与高危性行为和毒品相关行为有关。早期 HCV 诊断和治疗以及降低行为风险可能有效消除感染 HIV 的 MSM 中的 HCV。设计 我们开发了一个确定性动态区室模型，以模拟测试和治疗以及风险降低策略对法国 HIV 感染 MSM 中 HCV 流行（特别是发病率和患病率）的影响。我们考虑了 HIV 和 HCV 护理级联、HCV 自然史和 HCV 风险行为的异质性。该模型根据 2014 年至 2017 年期间在护理中感染 HIV 的 MSM 中观察到的原发性 HCV 发病率进行了校准（ANRS CO4-法国 HIV 医院数据库 (FHDH)）。结果 按照法国目前的做法（每年一次 HCV 筛查和立即治疗），HCV 总发病率将下降 70%，从 2015 年的 0.82/100 人年下降到 2030 年的 0.24/100 人年。如果筛查更加频繁，到 2030 年，HCV 发病率将下降至 0.19/100 人年，下降至 0.19 (0.12)/100到 2030 年，风险降低 20% (50%)。如果将每 3 个月进行一次筛查与风险降低 50% 相结合，到 2030 年，HCV 发病率将为 0.11/100 人年，从而接近 WHO 的目标（从 2015 年到 2030 年降低 90%）。同样，HCV 患病率将从 2015 年的 2.79% 降至 2030 年的 0.48%（当前做法为 0.71%）。结论 将检测与治疗和降低风险策略相结合，可以对 HCV 流行产生显着影响，为 HIV 感染者中 MSM 消除 HCV 铺平道路。
Objective Since the early 2000s, there has been an epidemic of HCV occurring among men who have sex with men (MSM) living with HIV, mainly associated with high-risk sexual and drug-related behaviours. Early HCV diagnosis and treatment, and behavioural risk-reduction, may be effective to eliminate HCV among MSM living with HIV. Design We developed a deterministic dynamic compartmental model to simulate the impact of test-and-treat and risk-reduction strategies on HCV epidemic (particularly on incidence and prevalence) among MSM living with HIV in France. We accounted for HIV and HCV cascades of care, HCV natural history and heterogeneity in HCV risk behaviours. The model was calibrated to primary HCV incidence observed between 2014 and 2017 among MSM living with HIV in care (ANRS CO4-French hospital database on HIV (FHDH)). Results With current French practices (annual HCV screening and immediate treatment), total HCV incidence would fall by 70%, from 0.82/100 person-years in 2015 to 0.24/100 person-years in 2030. It would decrease to 0.19/100 person-years in 2030 with more frequent screening and to 0.19 (0.12)/100 person-years in 2030 with a 20% (50%) risk-reduction. When combining screening every 3 months with a 50% risk-reduction, HCV incidence would be 0.11/100 person-years in 2030, allowing to get close to the WHO target (90% reduction from 2015 to 2030). Similarly, HCV prevalence would decrease from 2.79% in 2015 to 0.48% in 2030 (vs 0.71% with current practices). Conclusion Combining test-and-treat and risk-reduction strategies could have a marked impact on the HCV epidemic, paving the way to HCV elimination among MSM living with HIV.