Background

The proportion of undiagnosed hepatitis C virus (HCV) infections in high-risk populations, such as human immunodeficiency virus (HIV)–infected men who have sex with men (MSM) is unclear. Identification of potential HCV transmitters is important to reach World Health Organization HCV elimination targets.

Methods

Between October 2015 and May 2016, we performed a systematic HCV RNA–based screening among HIV-infected MSM participating in the Swiss HIV Cohort Study (SHCS). HCV antibodies were measured from all HCV RNA–positive samples.

Results

Of 4257 MSM recorded in the SHCS database, we screened 3722 (87%) by HCV polymerase chain reaction, and 177 (4.8%) harbored a replicating HCV infection. We identified 24 individuals (14%) with incident HCV infection; one-third of them had a negative HCV antibody result at the time of HCV RNA positivity. In a multivariable model, elevated liver enzyme values (odds ratio, 14.52; 95% confidence interval, 9.92–21.26), unprotected sex with occasional partners (2.01; 1.36–2.98), intravenous drug use (7.13; 4.36–11.64), noninjectable drug use (1.94; 1.3–2.88), and previous syphilis diagnosis (2.56; 1.74–3.76) were associated with HCV RNA positivity.

Conclusions

A systematic HCV RNA–based screening among HIV-infected MSM revealed a high number of potential transmitters. A substantial subpopulation of MSM had incident infection, one-third of whom had a negative HCV antibody test result at the time of the HCV RNA positivity. These data reveal that one-time RNA testing of a high-risk population for HCV RNA might identify more infected persons than routine testing for HCV antibodies and liver enzymes.

Clinical Trials Registration

NCT02785666

中文翻译：

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在人类免疫缺陷病毒感染的男性患者中进行的基于人群的系统性丙型肝炎病毒RNA筛选中揭示了大量潜在的变送器。

背景

目前尚不清楚在高风险人群中未诊断出的丙型肝炎病毒（HCV）感染的比例，例如人类免疫缺陷病毒（HIV）感染的与男性发生性关系（MSM）的男性。识别潜在的HCV传播者对于实现世界卫生组织HCV消除目标很重要。

方法

在2015年10月至2016年5月之间，我们对参与瑞士HIV队列研究（SHCS）的HIV感染的MSM进行了系统的基于HCV RNA的筛查。从所有HCV RNA阳性样品中测量HCV抗体。

结果

在SHCS数据库中记录的4257个MSM中，我们通过HCV聚合酶链反应筛选了3722个（87％），其中177个（4.8％）具有复制的HCV感染。我们确定了24例HCV感染个体（占14％）。三分之一的人在HCV RNA阳性时HCV抗体结果为阴性。在多变量模型中，肝酶值升高（比值比为14.52； 95％置信区间为9.92-21.26），与偶发伴侣无保护的性行为（2.01; 1.36-2.98），静脉内吸毒（7.13; 4.36-11.64），不可注射药物使用（1.94; 1.3–2.88）和先前的梅毒诊断（2.56; 1.74–3.76）与HCV RNA阳性相关。

结论

对HIV感染的MSM进行的基于HCV RNA的系统化筛查显示，大量潜在的传播者。MSM的大量亚群发生了事件感染，其中三分之一的人在HCV RNA阳性时HCV抗体检测结果为阴性。这些数据表明，与常规检测HCV抗体和肝酶相比，对高危人群进行HCV RNA的一次性RNA检测可能会发现更多的感染者。

临床试验注册

NCT02785666