Incidence of primary hepatitis C virus infection among people who inject drugs in Australia pre- and post-unrestricted availability of direct acting antiviral therapies
Incidence of primary hepatitis C virus infection among people who inject drugs in Australia pre- and post-unrestricted availability of direct acting antiviral therapies
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DOI：
10.1111/add.16113
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发表时间：
2022-12-29
期刊：
影响因子：
6
通讯作者：
Maher, Lisa
中科院分区：
文献类型：
--
作者：
Iversen, Jenny;Wand, Handan;Maher, Lisa
目标2016 年全球卫生部门病毒性肝炎战略 (GHSS) 的目标是到 2030 年将丙型肝炎病毒 (HCV) 新发感染减少 80%，其中到 2020 年减少 30%。这项研究旨在估计在通过澳大利亚药品福利计划不受限制地获得 HCV 直接抗病毒 (DAA) 治疗之前和之后全国注射吸毒者 (PWID) 样本中的原发性 HCV 感染情况2016年，设计了一种简单的确定性联系方法，在注射吸毒者中进行的系列横断面调查中识别出重复受访者。创建了两个独立的 HCV 抗体阴性受访者回顾性队列，对应于 DAA 之前（2010-15）和之后（2016-21）时间段。背景和参与者这项研究在澳大利亚进行。在 757 名保留的注射吸毒者中（DAA 前 376 名，DAA 后 381 名），一半以上是男性（60%），大多数是异性恋（80%），中位年龄为 40 岁（四分位距 = 33-46 岁），最后注射的主要药物是海洛因（24%）、阿片类药物（27%）和甲基苯丙胺（41%）。测量 主要结果是 HCV 血清转化，定义为 HCV 抗体检测结果呈阴性，随后 HCV 抗体结果呈阳性。使用人年（PY）方法估计初次感染 HCV 的时间。结果共鉴定出 376 例 (2010-15) 中的 97 例和 381 例 (2016-21) 例中的 41 例 HCV 血清转化。原发性 HCV 发病率减少了一半以上，从 2010-15 年的每 100 PY 13.6 [95% 置信区间 (CI) = 11.2, 16.6] 降至 2016-21 年的每 100 PY 5.4 (95% CI = 3.9, 7.3)。这种下降与两个时间段内观察到的人口和药物使用特征的差异无关（调整后的危险比 = 0.47，95% CI = 0.31-0.69，P < 0.001）。结论 2016 年 3 月，在不受限制地提供 HCV 直接抗病毒治疗后，澳大利亚注射吸毒者的原发性丙型肝炎病毒 (HCV) 发病率下降了 53%。鉴于吸毒者是澳大利亚 HCV 感染风险的主要人群，研究结果进一步证明澳大利亚可能已经实现了 2020 年全球卫生部门战略新感染人数下降 30% 的次级目标。
AimsThe 2016 Global Health Sector Strategy (GHSS) on viral hepatitis aims to reduce new hepatitis C virus (HCV) infections by 80% by 2030, including a 30% reduction by 2020. This study aimed to estimate primary HCV incident infection among a national sample of people who inject drugs (PWID) before and after the introduction of unrestricted access to HCV direct-acting antiviral (DAA) therapy via Australia's Pharmaceutical Benefits Scheme in 2016. DesignA simple deterministic linkage method identified repeat respondents in serial cross-sectional surveys conducted among PWID. Two separate retrospective cohorts of HCV antibody-negative respondents were created, corresponding to the pre- (2010-15) and post- (2016-21) DAA time-periods. Setting and ParticipantsThis study took place in Australia. Among 757 PWID retained (376 pre-DAA, 381 post-DAA), more than half were male (60%), the majority were heterosexual (80%), the median age was 40 years (interquartile range = 33-46 years) and the predominant drugs last injected were heroin (24%), pharmaceutical opioids (27%) and methamphetamine (41%). MeasurementsThe primary outcome was HCV seroconversion, defined as a negative HCV antibody test result followed by a positive HCV antibody result. Time to primary incident HCV infection was estimated using the person-years (PY) method. FindingsA total 97 of 376 (2010-15) and 41 of 381 (2016-21) HCV seroconversions were identified. Primary HCV incidence more than halved, from 13.6 per 100 PY [95% confidence intervals (CI) = 11.2, 16.6] in 2010-15 to 5.4 per 100 PY (95% CI = 3.9, 7.3) in 2016-21. The decline was independent of observed differences in demographic and drug use characteristics over the two time-periods (adjusted hazard ratio = 0.47, 95% CI = 0.31-0.69, P < 0.001). ConclusionsAustralia has had a 53% reduction in primary hepatitis C virus (HCV) incidence among people who inject drugs following unrestricted availability of HCV direct acting antiviral therapy in March 2016. Given that PWID are the predominant population at risk of HCV infection in Australia, findings add to the evidence that Australia has probably met its 2020 Global Health Sector Strategy subtarget of a 30% decline in new infections.