Reinfection after successful treatment with direct-acting antivirals is hypothesised to undermine efforts to eliminate hepatitis C virus (HCV) infection among people with HIV. We aimed to assess changes in incidence of HCV reinfection among people with HIV following the introduction of direct-acting antivirals, and the proportion of all incident cases attributable to reinfection. We pooled individual-level data on HCV reinfection in people with HIV after spontaneous or treatment-induced clearance of HCV from six cohorts contributing data to the International Collaboration on Hepatitis C Elimination in HIV Cohorts (InCHEHC) in Australia, Canada, France, the Netherlands, Spain, and Switzerland between Jan 1, 2010, and Dec 31, 2019. Participants were eligible if they had evidence of an HCV infection (HCV antibody or RNA positive test) followed by spontaneous clearance or treatment-induced clearance, with at least one HCV RNA test after clearance enabling measurement of reinfection. We assessed differences in first reinfection incidence between direct-acting antiviral access periods (pre-direct-acting antiviral, limited access [access restricted to people with moderate or severe liver disease and other priority groups], and broad access [access for all patients with chronic HCV]) using Poisson regression. We estimated changes in combined HCV incidence (primary and reinfection) and the relative contribution of infection type by calendar year. Overall, 6144 people with HIV who were at risk of HCV reinfection (median age 49 years [IQR 42–54]; 4989 [81%] male; 2836 [46%] men who have sex with men; 2360 [38%] people who inject drugs) were followed up for 17 303 person-years and were included in this analysis. The incidence of first HCV reinfection was stable during the period before the introduction of direct-acting antivirals (pre-introduction period; 4·1 cases per 100 person-years, 95% CI 2·8–6·0). Compared with the pre-introduction period, the average incidence of reinfection was 4% lower during the period of limited access (incidence rate ratio [IRR] 0·96, 95% CI 0·78–1·19), and 28% lower during the period of broad access (0·72, 0·60–0·86). Between 2015 and 2019, the proportion of incident HCV infections due to reinfection increased, but combined incidence declined by 34%, from 1·02 cases per 100 person-years (95% CI 0·96–1·07) in 2015 to 0·67 cases per 100 person-years (95% CI 0·59–0·75) in 2019. HCV reinfection incidence and combined incidence declined in people with HIV following direct-acting antiviral introduction, suggesting reinfection has not affected elimination efforts among people with HIV in InCHEHC countries. The proportion of incident HCV cases due to reinfection was highest during periods of broad access to direct-acting antivirals, highlighting the importance of reducing ongoing risks and continuing testing in people at risk. Australian National Health and Medical Research Council.

中文翻译：

---

2010-19 年六个国家的艾滋病毒感染者丙型肝炎病毒再感染发生率和获得直接作用抗病毒治疗的变化：对前瞻性队列研究联盟数据的分析

据推测，直接作用抗病毒药物成功治疗后的再感染会破坏消除艾滋病毒感染者中丙型肝炎病毒（HCV）感染的努力。我们的目的是评估引入直接抗病毒药物后艾滋病毒感染者中丙型肝炎病毒再感染发生率的变化，以及所有病例中可归因于再感染的比例。我们汇集了来自六个队列的 HIV 感染者在自发或治疗诱导清除 HCV 后 HCV 再感染的个人水平数据，为澳大利亚、加拿大、法国、荷兰的 HIV 队列消除丙型肝炎国际合作 (InCHEHC) 提供数据2010 年 1 月 1 日至 2019 年 12 月 31 日期间，西班牙和瑞士。如果参与者有 HCV 感染证据（HCV 抗体或 RNA 阳性检测），随后自发清除或治疗诱导清除，且至少有一项清除后进行 HCV RNA 测试，可测量再感染。我们评估了直接作用抗病毒药物使用期（直接作用前抗病毒药物、有限使用[仅限于中度或重度肝病患者和其他优先群体的使用]和广泛使用[所有患有肝病的患者使用]之间首次再感染发生率的差异。慢性 HCV]）使用泊松回归。我们按日历年估计了 HCV 综合发病率（原发感染和再感染）的变化以及感染类型的相对贡献。总体而言，6144 名 HIV 感染者有 HCV 再次感染的风险（中位年龄 49 岁 [IQR 42-54]；4989 名 [81%] 男性；2836 名 [46%] 男男性行为者；2360 名 [38%] 人对 17 303 人年进行了随访，并纳入本次分析。在引入直接作用抗病毒药物之前的时期（引入前；每100人年4·1例，95％CI 2·8–6·0），首次HCV再感染的发生率稳定。与引入前相比，限制进入期间再感染的平均发生率降低了4%（发生率比[IRR] 0·96，95% CI 0·78–1·19），降低了28%在广泛访问期间（0·72、0·60–0·86）。 2015年至2019年间，因再感染而导致HCV感染的比例有所增加，但综合发病率下降了34%，从2015年的每100人年1·02例（95% CI 0·96–1·07）降至0 · 2019 年每 100 人年有 67 例病例（95% CI 0·59–0·75）。在引入直接作用抗病毒药物后，HIV 感染者的 HCV 再感染发生率和综合发生率下降，表明再感染并未影响人群中的消除工作InCHEHC 国家的艾滋病毒感染者。在广泛获得直接作用抗病毒药物期间，由于再感染而导致的丙型肝炎病例比例最高，这凸显了减少持续风险和对高危人群持续进行检测的重要性。澳大利亚国家健康和医学研究委员会。