Are Interferon-Free Direct-Acting Antivirals for the Treatment of HCV Enough to Control the Epidemic among People Who Inject Drugs?
Are Interferon-Free Direct-Acting Antivirals for the Treatment of HCV Enough to Control the Epidemic among People Who Inject Drugs?
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DOI：
10.1371/journal.pone.0143836
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发表时间：
2015-12-03
期刊：
影响因子：
3.7
通讯作者：
Montaner, Julio S. G.
中科院分区：
文献类型：
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作者：
Lima, Viviane D.;Rozada, Ignacio;Montaner, Julio S. G.
背景广泛使用无干扰素的直接作用抗病毒治疗方案（无干扰素DAA）将极大地改变注射吸毒者（PWID）中HCV流行的影响。我们评估了长期的影响，增加丙型肝炎病毒检测，治疗和参与到减少危害的活动，专注于积极PWID，丙型肝炎病毒流行在不列颠哥伦比亚省（BC），加拿大。MethodsWe建立了一个房室模型的丙型肝炎病毒疾病传播分层疾病进展，传播风险和纤维化水平。我们探讨了以下因素的影响：（1）将治疗率从每1000名感染PWID/年8人提高到20、40和80人;（2）根据纤维化水平提高治疗资格;（3）在急性期结束后立即进行检测，以最大限度地发挥检测效果;（4）增加减少伤害活动的机会，以减少再次感染的风险;（5）不同HCV抗病毒方案对控制繁殖数R-c的影响。我们评估了这些干预措施对2016 - 2030年的发病率、患病率和死亡率的影响。结果在所有抗HCV方案中，只有不含IFN的DAA提供了很高的疾病消除机会（即R-c < 1），但有必要大幅提高目前较低的检测和治疗率。假设治疗率为每年每1000例感染的PWID 80例，加上高检测率，到2030年底，发病率可能从每年每1000例易感PWID 92.9例（现状）降至82.8例（仅治疗纤维化水平为F-2及以上的PWID）或65.5例（无论纤维化水平如何治疗PWID）。如果PWID也能获得更多的减少伤害活动，发病率进一步下降到每年每1000名易感PWID中有53.1人。2030年底HCV感染率和死亡率显著下降。结论提高HCV检测的可及性、高效的抗病毒治疗和降低危害计划相结合，可显著降低PWID人群的HCV流行负担。然而，除非我们提高目前的治疗和检测水平，否则卑诗省PWID和世界上具有类似流行病学背景的其他地区的HCV流行将在许多年内仍然是一个重大的公共卫生问题。
BackgroundWidely access to interferon-free direct-acting antiviral regimens (IFN-free DAA) is poised to dramatically change the impact of the HCV epidemic among people who inject drugs (PWID). We evaluated the long-term effect of increasing HCV testing, treatment and engagement into harm-reduction activities, focused on active PWID, on the HCV epidemic in British Columbia (BC), Canada.MethodsWe built a compartmental model of HCV disease transmission stratified by disease progression, transmission risk, and fibrosis level. We explored the effect of: (1) Increasing treatment rates from 8 to 20, 40 and 80 per 1000 infected PWID/year; (2) Increasing treatment eligibility based on fibrosis level; (3) Maximizing the effect of testing by performing it immediately upon ending the acute phase; (4) Increasing access to harm-reduction activities to reduce the risk of re-infection; (5) Different HCV antiviral regimens on the Control Reproduction Number R-c. We assessed the impact of these interventions on incidence, prevalence and mortality from 2016 to 2030.ResultsOf all HCV antiviral regimens, only IFN-free DAAs offered a high chance of disease elimination (i.e. R-c < 1), but it would be necessary to substantially increase the current low testing and treatment rates. Assuming a treatment rate of 80 per 1000 infected PWID per year, coupled with a high testing rate, the incidence rate, at the end of 2030, could decrease from 92.9 per 1000 susceptible PWID per year (Status Quo) to 82.8 (by treating only PWID with fibrosis level F-2 and higher) or to 65.5 (by treating PWID regardless of fibrosis level). If PWID also had access to increased harm-reduction activities, the incidence rate further decreased to 53.1 per 1000 susceptible PWID per year. We also obtained significant decreases in prevalence and mortality at the end of 2030.ConclusionsThe combination of increased access to HCV testing, highly efficacious antiviral treatment and harm-reduction programs can substantially decrease the burden of the HCV epidemic among PWID. However, unless we increase the current levels of treatment and testing, the HCV epidemic among PWID in BC, and in other parts of the world with similar epidemiological background, will remain a substantial public health concern for many years.