Changes in hepatitis C burden and treatment trends in Europe during the era of direct-acting antivirals: a modelling study
Changes in hepatitis C burden and treatment trends in Europe during the era of direct-acting antivirals: a modelling study
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DOI：
10.1136/bmjopen-2018-026726
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发表时间：
2019-06-01
期刊：
影响因子：
2.9
通讯作者：
Chhatwal, Jagpreet
中科院分区：
文献类型：
--
作者：
Chen, Qiushi;Ayer, Turgay;Chhatwal, Jagpreet
目的丙型肝炎病毒(HCV)的口服直接作用抗病毒药物(DAAs)极大地改变了治疗模式。我们的目标是预测法国、德国、意大利、西班牙和英国丙型肝炎诊断、治疗和疾病负担的时间趋势。设计一个丙型肝炎病毒感染自然历史的数学模拟模型。参与者根据特定国家的年龄、纤维化和基因分布定义丙型肝炎病毒感染患者。干预措施丙型肝炎筛查实践和每个国家不同浪潮的DAA治疗的可用性。结果衡量实现持续病毒学应答(SVR)的患者数量的时间趋势，结果2014-2030年欧洲五国将有132.4万人接受治疗，其中1.2万-3.7万人未能实现SVR。到2021年，治愈丙型肝炎病毒的人数将超过法国、德国、西班牙和英国的活跃感染人数。在目前情况下，到2030年，这些国家的诊断率将达到65%至75%，治疗覆盖率将达到65%至74%。治疗失败的患者将随着时间的推移而减少，大多数治疗失败的患者暴露于非结构蛋白5A抑制剂。结论在DAA时代，治愈的丙型肝炎患者数量将超过病毒感染患者的数量，但许多患者仍将未被诊断、未治疗、多次治疗失败并发展为晚期后遗症。需要扩大筛查和治疗能力以及及时和有效的再治疗，以充分利用DAA的好处并实现世卫组织设定的消除丙型肝炎目标。
Objectives Oral direct-acting antivirals (DAAs) for hepatitis C virus (HCV) have dramatically changed the treatment paradigm. Our aim was to project temporal trends in HCV diagnosis, treatment and disease burden in France, Germany, Italy, Spain and the UK.Design A mathematical simulation model of natural history of HCV infection.Participants HCV-infected patients defined based on country-specific age, fibrosis and genotype distributions.Interventions HCV screening practice and availability of different waves of DAA treatment in each country.Outcome measures Temporal trends in the number of patients who achieve sustained virological response (SVR), fail treatment (by drug regimen) and develop advanced sequelae from 2014 to 2030 in each country.Results We projected that 1 324 000 individuals would receive treatment from 2014 to 2030 in the five European countries and 12 000-37 000 of them would fail to achieve SVR. By 2021, the number of individuals cured of HCV would supersede the number of actively infected individuals in France, Germany, Spain and the UK. Under status quo, the diagnosis rate would reach between 65% and 75% and treatment coverage between 65% and 74% by 2030 in these countries. The number of patients who fail treatment would decrease over time, with the majority of those who fail treatment having been exposed to nonstructural protein 5A inhibitors.Conclusions In the era of DAAs, the number of people with HCV who achieved a cure will exceed the number of viraemic patients, but many patients will remain undiagnosed, untreated, fail multiple treatments and develop advanced sequelae. Scaling-up screening and treatment capacity, and timely and effective retreatment are needed to avail the full benefits of DAAs and to meet HCV elimination targets set by WHO.