The impact of direct-acting antivirals on hepatitis C viraemia among people who inject drugs in England; real-world data 2011-2018.
The impact of direct-acting antivirals on hepatitis C viraemia among people who inject drugs in England; real-world data 2011-2018.
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DOI：
10.1111/jvh.13575
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发表时间：
2021-10
影响因子：
2.5
通讯作者：
Phipps, Emily
中科院分区：
文献类型：
--
作者：
Bardsley, Megan;Heinsbroek, Ellen;Harris, Ross;Croxford, Sara;Edmundson, Claire;Hope, Vivian;Hassan, Nasra;Ijaz, Samreen;Mandal, Sema;Shute, Justin;Hutchinson, Sharon J.;Hickman, Matthew;Sinka, Katy;Phipps, Emily
关键词：
自2017年以来，英格兰扩大了针对任何病毒性丙型肝炎病毒感染患者的直接作用抗病毒(DAA)治疗。为了评估早期影响，我们调查了注射吸毒者(PWID)中丙型肝炎病毒血症的趋势及其相关因素。我们还检查了自我报告的治疗途径的趋势。来自PWID年度国家监测调查(2011-2018年)的生物行为数据估计了丙型肝炎抗体阳性PWID中病毒血症流行的趋势。多变量Logistic回归确定了与病毒血症独立相关的特征。对已知感染的PWID患者的治疗途径的趋势进行了检查。2011年至2016年，在抗体阳性的PWID中，病毒流行率保持稳定(2011年，57.7%；2016年，55.8%)，但在2017年(49.4%)和2018年(50.4%)有所下降(P<；均为0.001)。在对人口和行为特征进行调整后，与2016年相比，2017年(调整后的优势比[AOR]0.79，95%可信区间0.65-0.94)和2018年(调整后的优势比0.79，95%可信区间0.66-0.93)病毒血症的发病率仍有显著下降。与病毒血症有关的其他因素有男性(AOR 1.68，95%CI 1.53~1.86)、地域、过去一年注射(AOR 1.26，95%CI 1.13~1.41)、监禁(AOR 1.14，95%CI 1.04~1.31)和无家可归(AOR 1.17，95%CI 1.04~1.31)。在已知感染的非病毒型PWID中，报告曾接受治疗的比例在2017年(28.7%，P<0.001)和2018年(38.9%，P<0.001)比2016年(14.5%)有所上升。总之，自2016年以来，随着DAA规模的扩大，英国抗体阳性PWID中的丙型肝炎病毒血症略有下降，一些迹象表明，在同一时期，治疗的可及性有所改善。人口一级的监测和对减少危害的关注是实现和评估消除的关键。
Direct‐acting antiviral (DAA) therapy for anybody with viraemic HCV infection has been scaled‐up in England since 2017. To assess early impacts, we investigated trends in, and factors associated with, HCV viraemia among people who inject drugs (PWID). We also examined trends in self‐reported treatment access. Bio‐behavioural data from an annual, national surveillance survey of PWID (2011–2018) estimated trends in viraemic prevalence among HCV antibody‐positive PWID. Multivariable logistic regression identified characteristics independently associated with viraemia. Trends in treatment access were examined for PWID with known infection. Between 2011 and 2016, viraemic prevalence among antibody‐positive PWID remained stable (2011, 57.7%; 2016, 55.8%) but decreased in 2017 (49.4%) and 2018 (50.4%) (both p < 0.001). After adjustment for demographic and behavioural characteristics, there remained significant reduction in viraemia in 2017 (adjusted odds ratio [aOR] 0.79, 95% CI 0.65–0.94) and 2018 (aOR 0.79, 95% CI 0.66–0.93) compared to 2016. Other factors associated with viraemia were male gender (aOR 1.68, 95% CI 1.53–1.86), geographical region, injecting in past year (aOR 1.26, 95% CI 1.13–1.41), imprisonment (aOR 1.14, 95% CI 1.04–1.31) and homelessness (aOR 1.17, 95% CI 1.04–1.31). Among non‐viraemic PWID with known infection, the proportion reporting ever receiving treatment increased in 2017 (28.7%, p < 0.001) and 2018 (38.9%, p < 0.001) compared to 2016 (14.5%). In conclusion, there has been a small reduction in HCV viraemia among antibody‐positive PWID in England since 2016, alongside DAA scale‐up, and some indication that treatment access has improved in the same period. Population‐level monitoring and focus on harm reduction is critical for achieving and evaluating elimination.
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影响因子：
168.9
作者：
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欧洲监狱中的丙型肝炎：呼吁采取基于证据的应对措施。
影响因子：
3.7
作者：
Arain A;Robaeys G;Stöver H
通讯作者：
Stöver H