The hepatitis C virus epidemics in key populations (including people who inject drugs, prisoners and MSM): the use of direct-acting antivirals as treatment for prevention.
The hepatitis C virus epidemics in key populations (including people who inject drugs, prisoners and MSM): the use of direct-acting antivirals as treatment for prevention.
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DOI：
10.1097/coh.0000000000000179
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发表时间：
2015-09
影响因子：
4.1
通讯作者：
Hickman M
中科院分区：
文献类型：
--
作者：
Martin NK;Vickerman P;Dore GJ;Hickman M
注射吸毒者（PWID）和囚犯中的HCV负担很高，并且在男男性行为者（MSM）中的HIV感染者中增加，这些人是高收入国家HCV传播的关键人群，也可能在许多低收入和中等收入国家中发挥作用。在这些人群中使用HCV抗病毒治疗进行预防的兴趣越来越大。许多理论模型研究已经探索了HCV治疗在全球范围内对PWID预防的潜在影响，通常发现适度和可实现的HCV治疗水平，特别是无干扰素直接作用抗病毒治疗（无IFN DAA），可以在未来10-20年内大幅降低PWID中的HCV慢性患病率。此外，模拟研究表明，如果确保护理的连续性，或使用DAA缩短HCV治疗，则在监狱中进行HCV检测和治疗（包括预防福利）可能具有成本效益。在艾滋病毒感染的男男性行为者中进行的建模工作表明，尽管这一人群的治疗率很高，但可能需要进一步扩大HCV治疗规模。然而，没有实证研究探讨了HCV治疗是否可以降低HCV的患病率，并防止在那些有传播风险的人中继续传播。针对PWID、囚犯和MSM等关键人群的HCV治疗可能成为重要的HCV预防干预措施，特别是在无IFN的DAA时代。然而，迫切需要通过实证研究来检验这些假设。
The burden of HCV is high among people who inject drugs (PWID) and prisoners, and increasing among HIV-infected men who have sex with men (MSM), who are key populations for HCV transmission in high-income countries, and may also play a role in many in low and middle-income countries. There is increasing interest in the use of HCV antiviral treatment for prevention in these populations. Numerous theoretical modeling studies have explored the potential impact of HCV treatment for prevention among PWID in a range of global settings, generally finding that modest and achievable levels of HCV treatment, especially with interferon-free direct acting antiviral therapy (IFN-free DAAs), could substantially reduce HCV chronic prevalence among PWID within the next 10–20 years. Additionally, modelling studies have shown HCV testing and treatment in prison (including prevention benefits) could be cost-effective if continuity of care is ensured, or HCV treatments are shortened with DAAs. Modelling work among HIV-infected MSM has shown that further HCV treatment scale-up is likely required despite high treatment rates in this population. However, no empirical studies have explored whether HCV treatment can reduce HCV prevalence and prevent onwards transmission among those at risk of transmission. HCV treatment for key populations such as PWID, prisoners, and MSM could become an important HCV prevention intervention, especially in the IFN-free DAA era. However, there is an urgent need to test these hypotheses through empirical studies.