Treatment of hepatitis C as prevention: a modeling case study in Vietnam.
Treatment of hepatitis C as prevention: a modeling case study in Vietnam.
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DOI：
10.1371/journal.pone.0034548
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发表时间：
2012
期刊：
影响因子：
3.7
通讯作者：
White LJ
中科院分区：
文献类型：
--
作者：
Durier N;Nguyen C;White LJ
丙型肝炎（HCV）的治疗非常有效，50-90%的患者治愈。除了其自身对个人的好处，这很可能转化为减少传播，但这一现象尚未得到充分探讨。在越南进行的这项数学建模研究中，我们估计了注射吸毒者（IDUs）的HCV治疗可能实现的公共卫生效益。预计25%、50%和75%的慢性HCV感染的注射吸毒者（感染4年）的治疗覆盖率将在全面达到预期覆盖率后11年分别使慢性HCV病毒血症患病率降低21%、37%和50%。在恒定的50%覆盖率水平下，预计感染后3年、2年和1年的早期治疗可将慢性HCV病毒血症患病率降低46%、60%和85%。在后三种情况下，每提供100个疗程，分别可避免50、61和94例新感染。这些好处预计在目前的美沙酮维持治疗和针头/注射器交换计划的覆盖率低的背景下，这些服务的扩展显示出补充预防HCV治疗的好处。与各种情景相关的计划处理承诺被认为是合理的。我们的模型预测是鲁棒的调整模型参数值的不确定性。在越南的这一案例研究中，我们预计，除了治愈需要治疗的患者外，注射吸毒者的HCV治疗还将产生预防性羊群效应，从而大幅降低HCV传播和流行率。
Treatment of hepatitis C (HCV) is very effective, achieving a cure in 50–90% of patients. Besides its own good for individuals, this most likely translates in reduced transmission, but this phenomenon has yet to be fully explored. In this mathematical modeling study done in the context of Vietnam, we estimated the public health benefit that HCV therapy for injecting drug users (IDUs) may achieve. Treatment coverage of 25, 50 and 75% of chronically HCV-infected IDUs (4 years into infection) is predicted to reduce the chronic HCV viremia prevalence respectively by 21, 37 and 50%, 11 years after full scale up to the intended coverage. At a constant 50% coverage level, earlier treatment, 3, 2, and 1 year into infection is predicted to reduce the chronic HCV viremia prevalence by 46, 60 and 85%. In these later 3 scenarios, for every 100 treatment courses provided, a total of respectively 50, 61 and 94 new infections could be averted. These benefits were projected in the context of current low coverage of methadone maintenance therapy and needles/syringes exchange programs, and these services expansion showed complementary preventive benefits to HCV therapy. The program treatment commitment associated with the various scenarios is deemed reasonable. Our model projections are robust under adjustment for uncertainty in the model parameter values. In this case study in Vietnam, we project that treatment of HCV for injecting drug users will have a preventative herd effect in addition to curing patients in need for therapy, achieving a substantial reduction in HCV transmission and prevalence.
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DOI：
10.1111/j.1440-1746.2010.06238.x
发表时间：
2010-07-01
影响因子：
4.1
作者：
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DOI：
10.1007/s11524-009-9417-9
发表时间：
2010-03-01
影响因子：
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