Scaling up screening and treatment for elimination of hepatitis C among men who have sex with men in the era of HIV pre-exposure prophylaxis
Scaling up screening and treatment for elimination of hepatitis C among men who have sex with men in the era of HIV pre-exposure prophylaxis
复制标题
DOI：
10.1016/j.eclinm.2019.11.010
复制
发表时间：
2020-02-01
影响因子：
15.1
通讯作者：
Vickerman, Peter
中科院分区：
文献类型：
--
作者：
Macgregor, Louis;Desai, Monica;Vickerman, Peter
背景资料：常规的艾滋病毒暴露前预防（PrEP）和艾滋病毒护理预约为筛查男男性行为者（MSM）的丙型肝炎病毒感染（HCV）提供了机会。然而，水平的筛选需要实现世界卫生组织消除的目标，到2030年减少90%的丙型肝炎病毒的发病率之间的所有MSM.Methods：HCV/HIV传播模型进行了校准，以英国的艾滋病毒流行率之间的男男性接触者（4.7%）和慢性丙型肝炎病毒感染之间的艾滋病毒阳性男男性接触者（9.9%）和艾滋病毒阴性男男性接触者（1.2%）。假设PrEP在HIV阴性MSM中的覆盖率为12.5%，我们评估了到2030年，PrEP使用者和/或HIV诊断的MSM中每12/6个月进行一次HCV筛查（同时在诊断后6个月内完成直接作用的抗病毒治疗）的总体HCV发病率的相对降低（与2018年的水平相比）。我们估计，到2030年，艾滋病毒阴性的非PrEP使用者所需的额外筛查将使总体发病率降低90%。PrEP使用者中避孕套使用减少50%的效果（风险补偿）估计。每12或6个月筛查和治疗一次PrEP使用者的HCV，可使HCV发病率降低67.3%（不确定度范围52.7-79.2%）或70.2%（57.1-80.8%），如果对HIV确诊的MSM也进行同样频率的筛查，则分别提高到75.4%（59.0-88.6%）或78.8%（63.9-90.4%）。风险补偿通过以下方式减少了后一种预测：
Background: Routine HIV pre-exposure prophylaxis (PrEP) and HIV care appointments provide opportunities for screening men who have sex with men (MSM) for hepatitis C virus infection (HCV). However, levels of screening required for achieving the WHO elimination target of reducing HCV incidence by 90% by 2030 among all MSM are unknown.Methods: An HCV/HIV transmission model was calibrated to UK prevalence of HIV among MSM (4.7%) and chronic HCV infection among HIV-positive MSM (9.9%) and HIV-negative MSM (1.2%). Assuming 12.5% coverage of PrEP among HIV-negative MSM, we evaluated the relative reduction in overall HCV incidence by 2030 (compared to 2018 levels) of HCV screening every 12/6-months (alongside completing direct acting antiviral treatment within 6-months of diagnosis) in PrEP users and/or HIV-diagnosed MSM. We estimated the additional screening required among HIV-negative non-PrEP users to reduce overall incidence by 90% by 2030. The effect of 50% reduction in condom use among PrEP users (risk compensation) was estimated.Results: Screening and treating PrEP users for HCV every 12 or 6-months decreases HCV incidence by 67.3% (uncertainty range 52.7-79.2%) or 70.2% (57.1-80.8%), respectively, increasing to 75.4% (59.0-88.6%) or 78.8% (63.9-90.4%) if HIV-diagnosed MSM are also screened at same frequencies. Risk compensation reduces these latter projections by