| Summary: | 碩士 === 國立臺灣大學 === 醫學檢驗暨生物技術學研究所 === 106 === Hepatitis C virus (HCV) shares the similar transmission routes, that is body fluid and sexual contacts, with human immunodeficiency virus (HIV), and no vaccine can prevent their infection currently. According to World Health Organization (WHO), there are 37 million people infected with HIV globally, and among which, 2.3 million are HIV/HCV co-infected patients. HIV/HCV co-infection was shown to have higher risks of liver-related mortality. Previously, an increasing trend of HCV infection was observed among HIV-1 infected men who have sex with men (MSM). Therefore, it is critical to identify the risk factors associated with HCV infection in HIV-infected population, in the hope to early identify these patients for clinical treatment. Since the HCV genotypes will influence the selection of direct-acting antiviral agent (DAA) for HCV infection, the HCV genotypes in study subjects will also be determined. The aim of our study is to investigate the HCV seroprevalence, incidence, genotype distribution and risk factors for HCV infection in HIV patients in northern Taiwan. A total of 2,371 blood specimens from HIV-1-infected patients who received clinical care at National Taiwan University Hospital (NTUH) and were seronegative for HCV before 2016 were included for analysis. The anti-HCV IgG ELISA kit (Dia. Pro, Italy) was used to determine the HCV prevalence and incidence. The seropositive specimens were further confirmed by detection of HCV RNA viral loads (VL) (COBAS® AmpliPrep HCV Test, v2.0, Roche, USA) and their HCV genotypes by NS5B PCR and sequencing. For those HCV seropositive with undetectable HCV VL, a recombinant immunoblot assays (RIBA) kit (Mikrogen Diagnostik, Neureid, Germany) was used to confirm the HCV antibody responses. The HCV seroprevalence and incidence in 2016 are 1.77% (42/2,371) and 18.77 per 1,000 person/year (PY) (36/1,917.5), respectively. 94.4% (34/36) of the coinfected patients are MSM. Baseline syphilis (p＜0.001), 4-fold increase of serum RPR titer (p＜0.001), mean AST level (p=0.04), AST＞37 U/L (p＜0.001), mean ALT level (p＜0.001) and ALT＞41 U/L (p<0.001) were found to be associated factors for HCV seroconverter in a nested case-control study. Only mean ALT value (p<0.013) was associated with HCV seroconverter in the multivariate analysis. Of the 11 patients with undetectable HCV RNA, four were positive, one was borderline and six were negative by RIBA. Three patients with acute HCV infection was identified by pooled PCR screening of 300 ELISA-negative specimens from patients with CD4＜200 cells/uL or ALT＞41 U/L. Of the 34 HCV PCR positive specimens, the most prevalent HCV genotype was genotype 2a (17/34, 50%), followed by genotype 6a (9/34, 26%), genotype 1b (5/34, 15%), genotype 1a (2/34, 6%), and genotype 3a (1/34, 3%). Six HCV transmission clusters were identified by phylogenetic tree analysis, belonging to genotype 2a (3 clusters), 6a (2 clusters) and 1b (1 cluster), respectively. No sofosbuvir resistance-associated mutation S282T was identified in these patients. To sum up, regular screening of HCV antibody or even HCV RNA detection is suggested for the high risk group.
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