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

摘要/摘要 在美国，2.7据估计，有100万人患有慢性HCV感染，其中包括近130万 在惩教设施的人。注射毒品仍然是HCV传播的最常见途径 在最近的路易斯安那州新奥尔良的一个样本中，77%的注射毒品者（PWID）在1999年获得了HCV。 过去此外，据估计，89%的残疾人曾被监禁。HCV合并感染 艾滋病毒也特别常见，大约25%的艾滋病毒感染者（PLWH）同时感染 丙肝病毒。此外，约80%的注射毒品的艾滋病毒携带者也患有HCV。由于艾滋病毒相关的发病率和 艾滋病毒感染者的死亡率在ART时代有所下降，HCV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一个重要原因，特别是在PWID中。PWID和PLWH是 在被监禁的人群中比例过高。 本研究的目的是探讨HCV治疗对HIV/HCV合并感染者的影响。 和HCV单一感染的监禁人员对HCV消除的影响。特别重要的是理解 为什么安全，治愈性治疗尚未达到大多数被监禁的HCV感染者， 不知道自己的感染状况。HCV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提供了巨大的激励，以掩盖流行病学和治疗。 丙肝病毒。对检测和治疗的微妙甚至公开的障碍持续存在，以减少净经济效益。 冲击因此，相对于艾滋病毒，在2000年至2005年期间， 美国路易斯安那州通过建立替代支付策略，将药物成本作为一个因素删除 目标是到2024年在其HCV消除计划中治疗80%的HCV感染者。下 根据该计划，路易斯安那州为HCV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HCV在 美国一个州的惩教系统、监禁的动态以及由此导致的感染流行。 我们希望将这一新的知识应用于估计治疗对社区HCV的潜在影响 传播和死亡率。在下一个周期中，我们提出了实现这些目标的研究：（1）表征 HIV/HCV混合感染者和HCV单一感染者在惩教系统中的感染动态 （2）评估治疗效果，作为HCV感染者中HCV病毒血症下降的轨迹 抗体阳性的被监禁者，以及艾滋病毒感染者和非感染者之间的这种轨迹是否不同; (3)为了弄清HCV纠正治疗方案对HCV病毒血症下降的影响， 评估路易斯安那州扩大矫正治疗计划对HCV发病率和死亡率的影响 和其他地方。

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.