The Impact of HCV Treatment in HIV/HCV coinfected and HCV monoinfected Incarcerated Persons on HCV Elimination

摘要/摘要 在美国，估计有270万人患有慢性丙型肝炎病毒，其中包括近130万人 教养所中的个人。注射吸毒仍然是丙型肝炎病毒最常见的传播途径 在路易斯安那州新奥尔良最近的一份样本中，77%的注射吸毒者(PWID)在 过去的事。此外，据估计，89%的残疾人曾被监禁。丙型肝炎病毒合并感染 艾滋病毒也特别常见，大约25%的艾滋病毒携带者(PLWH)也与 丙型肝炎。此外，大约80%注射毒品的PLWH也感染了丙型肝炎病毒。作为艾滋病毒相关的发病率和 在抗逆转录病毒治疗时代，PLWH的死亡率有所下降，丙型肝炎病毒是肝癌和肝功能衰竭的主要原因， 已成为发病率和死亡率的重要原因，特别是在PWID中。PWID和PLWH是 在被监禁的人口中有不成比例的代表。 这项研究建议的目的是调查丙型肝炎病毒治疗对艾滋病毒/丙型肝炎病毒混合感染的影响 和单一感染丙型肝炎病毒的监禁人员对丙型肝炎病毒的消除。尤其重要的是理解 为什么大多数被监禁的丙型肝炎病毒感染者还没有得到安全、根治的治疗，他们大多是 不知道自己的感染情况。丙型肝炎病毒治疗的高成本是造成这种知识差距的主要原因。 高昂的治疗价格为各州掩盖疟疾的流行病学和治疗提供了巨大的激励 丙型肝炎。对检测和治疗的微妙甚至公开的障碍持续存在，以减少净经济 冲击力。因此，相对于艾滋病毒，在墨西哥的惩教设施中进行的丙型肝炎病毒检测和治疗很少。 美国路易斯安那州通过建立替代支付策略，取消了作为一个因素的药物费用 目标是到2024年在他们的丙型肝炎消除计划中治疗80%的丙型肝炎病毒感染者。在.之下 计划，路易斯安那州为丙型肝炎药物支付相同的金额，无论有多少人接受治疗。 因此，现在我们第一次有机会严格调查丙型肝炎病毒在 美国一个州的惩教制度，监禁的动态，以及由此导致的感染流行。 我们希望将这一新知识应用于评估治疗对社区丙型肝炎病毒的潜在影响。 传播和死亡率。在下一个周期中，我们建议进行研究以实现这些目标：(1)表征 HIV/丙型肝炎病毒混合感染者和丙型肝炎病毒单独感染者矫正系统中丙型肝炎病毒感染的动态观察 被监禁者；(2)评估治疗对丙型肝炎病毒血症的影响 抗体阳性的监禁者以及这一轨迹在感染和不感染艾滋病毒的人之间是否有所不同； (3)厘清丙型肝炎病毒治疗方案对丙型肝炎病毒下降的影响，并 评估路易斯安那州扩大矫正治疗计划对丙型肝炎发病率和死亡率的影响 还有其他地方。

Summary/Abstract In the U.S., 2.7 million individuals are estimated to have chronic HCV infection which includes nearly 1.3 million individuals in correctional facilities. Injection drug use remains the most common route of HCV transmission and in a recent New Orleans, Louisiana sample, 77% of people who inject drugs (PWID) had acquired HCV in the past. Moreover, it is estimated that 89% of PWID have experienced incarceration. HCV coinfection with HIV is also particularly common with approximately 25% of people living with HIV (PLWH) also coinfected with HCV. Furthermore, about 80% of PLWH who inject drugs also have HCV. As HIV-related morbidity and mortality have declined among PLWH in the ART era, HCV, a leading cause of liver cancer and liver failure, has emerged as an important cause of morbidity and mortality especially among PWID. PWID and PLWH are disproportionately represented in incarcerated populations. The purpose of this research proposal is to investigate the impact of HCV treatment of HIV/HCV coinfected and HCV monoinfected incarcerated persons on HCV elimination. Of particular importance is understanding why safe, curative treatment has not reached most of the incarcerated HCV infected persons who largely are unaware of their infected status. The high cost of HCV treatment is a major reason for this knowledge gap. High treatment prices provide an enormous incentive for states to shroud the epidemiology and treatment of HCV. Subtle and even overt barriers to testing and treatment are sustained to diminish the net economic impact. Accordingly, relative to HIV, little HCV testing and treatment has occurred in correctional facilities in the U.S. Louisiana removed the cost of medications as a factor by establishing an alternative payment strategy with the goal of treating 80% of HCV infected persons by 2024 in their HCV Elimination Program. Under the program, Louisiana pays the same amount for HCV medications no matter how many persons are treated. Thus, now for the first time, we have the opportunity to investigate rigorously the burden of HCV in the correctional system in a U.S. state, the dynamics of incarceration, and the resulting prevalence of infection. We want to apply this new knowledge to estimating the potential impact of treatment on community HCV transmission and mortality. In the next cycle, we propose research to achieve these aims: (1) To characterize the dynamics of HCV infection in the correctional system among HIV/HCV coinfected and HCV monoinfected incarcerated persons; (2) To assess treatment impact as the trajectory of decline in HCV viremia among HCV antibody positive incarcerated persons and whether this trajectory differs between those with and without HIV; (3) To disentangle the impact of the correctional HCV treatment program on HCV viremic decline, and to assess the impact of scale-up of correctional treatment programs on HCV incidence and mortality in Louisiana and elsewhere.