Elimination of HCV and related liver disease among HIV-infected and -uninfected people who inject drugs

项目摘要 由于丙型肝炎病毒（HCV）治疗的最新创新使根除HCV成为可能， 由于几乎每个人都有感染，世界卫生组织呼吁全球HCV 到2030年消除。消除意味着减少90%的事件感染和HCV相关的 死亡率从2015年的基准下降了65%。然而，新感染的发病率很高， 阿片类药物流行扩大和历史性低HCV治疗吸收的再感染可能 注射毒品者（PWID）中的HCV消除受到威胁， 美国.在这项资助中，我们询问目标是否达到，以及哪些亚群 在关注巴尔的摩的PWID之前，特别是那些同时感染艾滋病毒的人。 25年多来，我们一直在研究艾滋病毒、丙型肝炎病毒（HCV）和肝脏疾病， 一个以社区为基础的PWID队列（称为ALIVE），现在该队列是理想的环境， 实现我们的目标是：（1）评估HCV病毒血症下降的轨迹， 在所有口服HCV治疗的时代，以社区为基础的护理中和护理外PWID队列， 评估这种轨迹是否与HIV/HCV合并感染者和HCV感染者不同 单感染;（2）估计发病率，治疗和再感染对HCV的贡献 HIV感染和未感染巴尔的摩PWID之间的病毒血症变化;以及（3）评估 扩大HCV治疗对肝病结局（包括进展）的人群影响 以及与未感染PWID相比，HIV感染者出现不同类型的肝脏疾病。 我们对ALIVE队列中的肝病进行了详细的纵向测量。现在是正确的 时间来实现这些目标，以便我们可以评估，如果巴尔的摩（可能还有其他城市） 美国的一些地区）正在消除HCV的轨道上，并及时帮助指导这些未来的努力 调整公共卫生实践，确保到2030年实现这些目标。

Project summary Since recent innovations in hepatitis C virus (HCV) treatment make it possible to eradicate HCV infection in nearly every individual, the World Health Organization is calling for global HCV elimination by 2030. Elimination means reducing incident infection by 90% and HCV-related mortality by 65% from a 2015 benchmark. However, a high incidence of new infections and reinfections from the expanding opioid epidemic and historic low HCV treatment uptake might threaten HCV elimination among people who inject drugs (PWID), the primary HCV risk group in the USA. In this grant we asking both whether targets are being met and which subpopulations are being left befind focusing on Baltimore PWID, especially those coinfected with HIV. For more than 25 years, we have investigated HIV, hepatitis C virus (HCV) and liver disease in a community-based cohort of PWID (called ALIVE) and now the cohort is the ideal setting to accomplish our aims which are: (1) to evaluate the trajectory of decline in HCV viremia among a community-based cohort of in- and out-of care PWID in the era of all oral HCV therapy and assess whether this trajectory differs for those who are HIV/HCV co-infected and HCV monoinfected; (2) to estimate the contribution of incidence, treatment, and reinfection to HCV viremia changes among HIV-infected and -uninfected Baltimore PWIDs; and (3) to assess the population impact of expanded HCV treatment on liver disease outcomes including progression and emergence of different types of liver disease in HIV-infected compared to uninfected PWID. We have detailed, longitudinal measures of liver disease in the ALIVE cohort. Now is the right time to accomplish these aims so that we can assess if Baltimore (and possibly other urban areas in the USA) are on track for HCV elimination and to help guide those future efforts in time to adjust public health practices to ensure the goals are met by 2030.