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

项目总结 由于最近丙型肝炎病毒(丙型肝炎病毒)治疗的创新使根除丙型肝炎成为可能 几乎每个人都感染了丙型肝炎病毒，世界卫生组织呼吁在全球范围内 到2030年将被淘汰。消除意味着将感染事件减少90%，并与丙型肝炎病毒相关 死亡率比2015年的基准下降了65%。然而，新感染和新感染的高发病率 不断扩大的阿片类药物流行和历史性的低丙型肝炎治疗吸入率的再次感染可能 威胁在注射毒品者中消除丙型肝炎病毒(PWID)，这是#年丙型肝炎病毒的主要危险群体 美国。在这笔拨款中，我们询问是否实现了目标，以及哪些亚群 被留在关注巴尔的摩PWID的人，特别是那些合并感染艾滋病毒的人。 25年多来，我们一直在研究艾滋病毒、丙型肝炎病毒(丙型肝炎病毒)和肝病 基于社区的PWID队列(称为Alive)，现在队列是实现以下目标的理想环境 我们的目标是：(1)评估中国人群中丙型肝炎病毒血症的下降趋势。 全口服丙型肝炎治疗和非丙型肝炎治疗时代的社区住院和出院PWID队列 评估艾滋病毒/丙型肝炎病毒混合感染者和丙型肝炎病毒感染者的这一轨迹是否不同 单次感染；(2)估计发病、治疗和再感染对丙型肝炎病毒的贡献 感染和未感染HIV的巴尔的摩PWID患者中病毒血症的变化；以及(3)评估 扩大丙型肝炎病毒治疗对包括进展在内的肝病转归的人群影响 与未感染的PWID相比，HIV感染者出现不同类型的肝病。 我们在活着的队列中有详细的、纵向的肝病测量。现在是正确的 实现这些目标的时间到了，这样我们就可以评估巴尔的摩(可能还有其他城市 美国)正在消除丙型肝炎病毒的轨道上，并帮助及时指导这些未来的努力 调整公共卫生做法，以确保到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.