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“消除”背景下的丙型肝炎病毒感染现状及筛查、诊断对策

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  • 北京大学人民医院,北京大学肝病研究所,丙型肝炎和肝病免疫治疗北京市重点实验室,非酒精性脂肪性肝病诊断北京市国际科技合作基地,北京 100044
饶慧瑛 E-mail:rao.huiying@163.com

收稿日期: 2024-02-07

  网络出版日期: 2024-05-30

基金资助

MAFLD宿主-肠菌共代谢分子标志物探索及临床验证;国家重点研发计划(2022YFA1303804)

Current status, screening and diagnostic strategies for hepatitis C virus infection in the context of “elimination”

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  • Peking University People’s Hospital, Institute of Hepatology Peking Universter, Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, Beijing International Cooperation Base for Science and Technology on NAFLD Diagnosis, Beijing 100044, China

Received date: 2024-02-07

  Online published: 2024-05-30

摘要

2015年,丙型肝炎病毒(hepatitis C virus ,HCV)感染的全球流行率为0.9%,但随着病毒性肝炎清除工作的全面铺开,至2020年,HCV在全球的流行率已降至0.7%,但全球仍有约5 800万HCV感染者和1 500万新发感染者,每年的HCV相关死亡病例达30万。2019年,我国HCV新发感染病例数达62.5万,经年龄校正后的发病率为[55 (47.5~63.2)]/106。2006年,我国血清样本检测的流行病学调查显示,我国HCV感染的流行率约为0.43%。2016年的数据提示,我国的HCV相关死亡为45 300例,为全球高死亡率的地区。2022年,世界卫生组织(World Health Organization,WHO)提出了新的HCV消除结局指标,为HCV新发感染病例数<350 000例/年并在总人群中发病率<2/100 000 /年,静脉药瘾者(people who inject drugs, PWID)<2/100人年。我国HCV基因型分布亦呈现一定的特殊性,基因型以1b型为主,约占62.7%,其次为2a型(17.4%),西南地区3型(5%)呈现较高流行率。近年来,基因3b型占比除在我国北部地区有所下降,在其他地区均呈上升趋势。我国基因型及亚型的分布和演变增加了我国丙型肝炎(丙肝)消除的难度。WHO建议筛查高风险人群(PWID和囚犯等),并根据医疗记录调整高风险人群的筛查模式;政府应组织高流行区(抗HCV血清流行率≥2%或≥5%)的大规模筛查。HCV感染风险持续人群的再感染率约为4.13/100人年,PWID为2.84/100人年,男男性行为者为7.37/100人年,囚犯人群则为7.23/100人年。因此,WHO建议应对HCV感染风险持续人群在HCV治愈后进行重复HCV检测。2022年,WHO HCV指南和2022年WHO HCV简化医疗服务和诊断流程文件均建议简化HCV诊断路径。我国的HCV疾病负担沉重,目前我国的HCV感染和诊治现状距离2030年实现“消除病毒性肝炎的公共卫生危害的目标”尚有一定差距。

本文引用格式

黄睿, 饶慧瑛 . “消除”背景下的丙型肝炎病毒感染现状及筛查、诊断对策[J]. 诊断学理论与实践, 2024 , 23(01) : 1 -8 . DOI: 10.16150/j.1671-2870.2024.01.001

Abstract

Global prevalence of HCV infection was 0.9% in 2015. With the comprehensive rollout of viral hepatitis elimination efforts, the global prevalence of HCV infection has been reduced to 0.7% by 2020. However, there are still approximately 58 million people living with HCV globally and 15 million newly-diagnosed infections annually ,with 300 000 deaths per year. In 2019, the number of reported newly-diagnosed HCV cases in China reached 625 000, with an age-adjusted incidence rate of 55(47.5-63.2) per million. An epidemiological survey of serum samples in China in 2006 showed that the prevalence of HCV infection in the country was about 0.43%. Data in 2016 indicated that there were 45 300 HCV-related deaths in China, which was the region with highest mortality risk globally. In 2022, WHO proposed new outcome indicators for HCV elimination, including the number of newly-diagnosed HCV patients <350 000 cases per year, incidence of HCV <2/100 000 per year in total population,and incidence for people who inject drugs(PWID) <2/100 person-years. The distribution of HCV genotypes in China also presents certain particularities. Genotype 1b is predominant, accounting for about 62.7%, followed by genotype 2a (17.4%).There is a high prevalence of genotype 3 (5%) in the southwestern region. In recent years, the proportion of genotype 3b has shown a downward trend in the northern regions of China, but an upward trend in other areas. The distribution and evolution of genotypes and subtypes in China have increased the difficulty of eliminating hepatitis C in the country. The WHO recommends screening in high-risk populiation (PWID and prisoners, etc.) and adjusting screening patterns for high-risk groups based on medical records, as well as the government organizing large-scale screen in areas with high prevalence (anti-HCV sero-prevalence ≥ 2% or ≥ 5%). The reinfection rate among people with ongoing risk of HCV infection ,PWID,MSM and prisoners is about 4.13/100 person-years, 2.84/100 person-years, 7.37/person-years, and 7.23/100 person-years ,respectively. Therefore, the WHO suggests repeating HCV testing in people with ongoing risk of HCV infection after HCV cure. Both the 2022 WHO HCV guidelines and the 2022 WHO document on simplified medical services and diagnostic processes for HCV recommend simplifying the HCV diagnostic pathway. The burden of HCV disease in China is heavy, and there still is a certain gap between the current status of HCV infection and treatment and the goal of achieving the goal of eliminating viral hepatitis by 2030.

参考文献

[1] WHO Guidelines Approved by the Guidelines Review Committee. Global health sector strategies on, respectively, HIV, viral hepatitis and sexually transmitted infections for the period 2022-2030[M]. Geneva: World Health Organization, 2022.
[2] Polaris Observatory HCV Collaborators. Global change in hepatitis C virus prevalence and cascade of care between 2015 and 2020: a modelling study[J]. Lancet Gastroenterol Hepatol, 2022, 7(5):396-415.
[3] World Health Organization. Estimated mortality rate from cirrhosis and other chronic liver diseases[M/OL]. [https://www.who.int/data/gho/indicator-metadata-registry/imr-details/1179]
[4] YOUNOSSI Z M, WONG G, ANSTEE Q M, et al. The Global Burden of Liver Disease[J]. Clin Gastroenterol Hepatol, 2023, 21(8):1978-1991.
[5] ALBERTS C J, CLIFFORD G M, GEORGES D, et al. Worldwide prevalence of hepatitis B virus and hepatitis C virus among patients with cirrhosis at country, region, and global levels: a systematic review[J]. Lancet Gastroenterol Hepatol, 2022, 7(8):724-735.
[6] HUANG D Q, TERRAULT N A, TACKE F, et al. Global epidemiology of cirrhosis - aetiology, trends and predictions[J]. Nat Rev Gastroenterol Hepatol, 2023, 20(6): 388-398.
[7] CAO G, LIU J, LIU M. Global, regional, and national trends in incidence and mortality of primary liver cancer and its underlying etiologies from 1990 to 2019: Results from the global burden of disease study 2019[J]. J Epidemiol Glob Health, 2023, 13(2):344-360.
[8] NGUYEN V H, HUANG D Q, LE M H, et al. Global treatment rate and barriers to direct-acting antiviral therapy: A systematic review and meta-analysis of 146 studies and 1?760?352 hepatitis C virus patients[J]. Liver Int, 2023, 43(6):1195-1203.
[9] 李健, 庞琳, 李东民, 等. 2015-2021年我国丙型肝炎病例报告与哨点监测分析[J]. 中国艾滋病性病, 2023, 29(6):634-638.
  LI J, PANG L, LI D, et al. Hepatitis C case report and sentinel surveillance in China from 2015 to 2021[J]. Chin J AIDS STD, 2023, 29(6):634-638.
[10] YANG J, QI J L, WANG X X, et al. The burden of hepatitis C virus in the world, China, India, and the United States from 1990 to 2019[J]. Front Public Health, 2023,11:1041201.
[11] CHEN Y S, LI L, CUI F Q, et al. A sero-epidemiological study on hepatitis C in China[J]. Zhonghua Liu Xing Bing Xue Za Zhi, 2011, 32(9):888-891.
[12] CHEN Y, SHEN Z, MORANO J P, et al. Bridging the epidemic: a comprehensive analysis of prevalence and correlates of HIV, hepatitis C, and syphilis, and infection among female sex workers in Guangxi Province, China[J]. PLoS One, 2015, 10(2):e0115311.
[13] ZHAO Z, CHU M, GUO Y, et al. Feasibility of Hepatitis C Elimination in China: From Epidemiology, Natural History, and Intervention Perspectives[J]. Front Microbiol, 2022,13:884598.
[14] BAO Y, LARNEY S, PEACOCK A, et al. Prevalence of HIV, HCV and HBV infection and sociodemographic characteristics of people who inject drugs in China: A systematic review and meta-analysis[J]. Int J Drug Policy, 2019,70:87-93.
[15] ZHANG Y, CHEN L M, HE M. Hepatitis C virus in mainland China with an emphasis on genotype and subtype distribution[J]. Virol J, 2017, 14(1):41.
[16] 王晓忠, 魏来. 中国慢性丙型肝炎基因3型患者的现状、治疗和展望[J]. 中华肝脏病杂志, 2020, 28(10):824-826.
  WANG X Z, WEI L. Current status, treatment and prospect of patients with chronic hepatitis C genotype 3 in China[J]. Chin J Hepatol, 2020, 28(10):824-826.
[17] LU J, FENG Y, CHEN L, et al. Subtype-specific prevalence of hepatitis C virus NS5A resistance associated substitutions in mainland China[J]. Front Microbiol, 2019,10:535.
[18] YANG J, LIU H X, SU Y Y, et al. Distribution and changes in hepatitis C virus genotype in China from 2010 to 2020[J]. World J Clin Cases, 2022, 10(14):4480-4493.
[19] WHO Guidelines Approved by the Guidelines Review Committee. Guidance for country validation of viral hepatitis elimination and path to elimination:Technical document[M]. Geneva: World Health Organization, 2023.
[20] WHO Guidelines Approved by the Guidelines Review Committee. Updated recommendations on treatment of adolescents and children with chronic HCV infection, and HCV simplified service delivery and diagnostics[M]. Geneva: World Health Organization, 2022.
[21] 中联肝健康促进中心, 中华医学会肝病学分会, 中华医学会检验医学分会, 等. 中国丙型病毒性肝炎院内筛查管理流程(试行)[J]. 临床肝胆病杂志, 2021, 37(7):1534-1539.
  China Liver Health, Chinese Society of Hepatology, Chinese Society of Laboratory Medicine, et al. In-hospital process for viral hepatitis C screening and management in China (Draft)[J]. J Clin Hepatol, 2021, 37(7):1534-1539.
[22] WHO Guidelines Approved by the Guidelines Review Committee. WHO guidelines on hepatitis B and C testing[M]. Geneva: World Health Organization, 2017.
[23] TAHA G, EZRA L, ABU-FREHA N. Hepatitis C elimination: opportunities and challenges in 2023[J]. Viruses, 2023, 15(7):1413.
[24] GUSS D, SHERIGAR J, ROSEN P, et al. Diagnosis and management of hepatitis C infection in primary care settings[J]. J Gen Intern Med, 2018, 33(4):551-557.
[25] ZHUANG H W L, WANG G Q. Health China 2030 White Paper on Action to Eliminate the Threat of Hepatitis C 2030[M/OL]. 2022[http://liver.org.cn/portal.php?mod=view&aid=776]
[26] ABU-FREHA N, MATHEW JACOB B, ELHOASHLA A, et al. Chronic hepatitis C: Diagnosis and treatment made easy[J]. Eur J Gen Pract, 2022, 28(1):102-108.
[27] 中华医学会肝病学分会, 中华医学会感染病学分会. 丙型肝炎防治指南(2022年版)[J]. 中华肝脏病杂志, 2022, 30(12):1332-1348.
  Chinese Society of Hepatology, Chinese Society of Infectious Diseases. [Guideline for the prevention and treatment of hepatitis C (2022 version)][J]. Chin J Infect Dis, 2022, 30(12):1332-1348.
[28] LITWIN A H, DROLET M, NWANKWO C, et al. Perceived barriers related to testing, management and treatment of HCV infection among physicians prescribing opioid agonist therapy: The C-SCOPE Study[J]. J Viral Hepat, 2019, 26(9):1094-1104.
[29] VAN SANTEN D K, SACKS-DAVIS R, DOYLE J S, et al. Measuring hepatitis C virus elimination as a public health threat: Beyond global targets[J]. J Viral Hepat, 2020, 27(8):770-773.
[30] MALESPIN M, HARRIS C, KANAR O, et al. Barriers to treatment of chronic hepatitis C with direct acting antivirals in an urban clinic[J]. Ann Hepatol, 2019, 18(2):304-309.
[31] WHO Guidelines Approved by the Guidelines Review Committee. Updated recommendations on simplified service delivery and diagnostics for hepatitis C infection: policy brief[M]. Geneva: World Health Organization, 2022.
[32] CUNNINGHAM E B, WHEELER A, HAJARIZADEH B, et al. Interventions to enhance testing and linkage to treatment for hepatitis C infection for people who inject drugs: A systematic review and meta-analysis[J]. Int J Drug Policy, 2023,111:103917.
[33] CUNNINGHAM E B, WHEELER A, HAJARIZADEH B, et al. Interventions to enhance testing, linkage to care, and treatment initiation for hepatitis C virus infection: a systematic review and meta-analysis[J]. Lancet Gastroenterol Hepatol, 2022, 7(5):426-445.
[34] DUCHESNE L, HEJBLUM G, TOURE KANE N C, et al. Model-based cost-effectiveness estimates of testing strategies for diagnosing hepatitis C virus infection in people who use injecting drugs in Senegal[J]. Int J Drug Policy, 2020,75:102613.
[35] BHATTACHARYA D, ARONSOHN A, PRICE J, et al. Hepatitis C Guidance 2023 Update: AASLD-IDSA Recom-mendations for Testing, Managing, and Treating Hepatitis C Virus Infection[J]. Clin Infect Dis, 2023,ciad319.
[36] MUNARI S C, TRAEGER M W, MENON V, et al. Determining reinfection rates by hepatitis C testing interval among key populations: A systematic review and meta-analysis[J]. Liver Int, 2023, 43(12):2625-2644.
[37] WHO Guidelines Approved by the Guidelines Review Committee. New recommendation on hepatitis C virus testing and treatment for people at ongoing risk of infection: policy brief[M]. Geneva: World Health Organization, 2023.
[38] AHMADI GHARAEI H, FARAROUEI M, MIRZAZADEH A, et al. The global and regional prevalence of hepatitis C and B co-infections among prisoners living with HIV: a systematic review and meta-analysis[J]. Infect Dis Pove-rty, 2021, 10(1):93.
[39] WHO Guidelines Approved by the Guidelines Review Committee. Recommended package of interventions for HIV, viral hepatitis and STI prevention, diagnosis, treatment and care for people in prisons and other closed settings: policy brief[M]. Geneva: World Health Organization, 2023.
[40] WHO Guidelines Approved by the Guidelines Review Committee. Recommendations and guidance on hepatitis C virus self-testing[M]. Geneva: World Health Organization, 2021.
[41] SIMMONDS P, HOLMES E C, CHA T A, et al. Classification of hepatitis C virus into six major genotypes and a series of subtypes by phylogenetic analysis of the NS-5 region[J]. J Gen Virol, 1993, 74(Pt 11):2391-2399.
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