Hepatitis C virus treatment for prevention among people who inject drugs

Modeling treatment scale-up in the age of direct-acting antivirals

Datos Bibliográficos

ID23326646
AutoresNatasha K Martins (0000-0001-8344-1810, University of Bristol, autor de correspondencia), Natasha K Martin, Peter Vickerman (0000-0002-8291-5890, London School of Hygiene & Tropical Medicine), J Grebely (0000-0002-1833-2017, UNSW Sydney), Margaret Hellard (0000-0002-5055-3266, Burnet Institute), Sharon Hutchinson (0000-0002-6891-6758, Glasgow Caledonian University), Sharon J Hutchinson, Valentina Dorea Lima (0000-0003-4943-091X, University of British Columbia), Viviane D Lima, Graham R Foster (0000-0002-3704-386X, Queen Mary University of London), Jessica Dillon (0000-0002-2164-4476, University of Dundee), John F Dillon, David J Goldberg (0000-0002-8950-439X), David Goldberg (0000-0002-4194-2067, Health Protection Scotland), Gregory J Dore (0000-0002-4741-2622, UNSW Sydney), Matthew Hickman (0000-0001-9864-459X, University of Bristol)
Año2013
Volumen58
Número5
Páginas1598-1609
Fecha de publicación2013-11-01
Peer ReviewedSí
Open AccessSí
TipoARTICLE
RevistaHepatology (JOURNAL)
Identificadores de la revistaISSN: 0270-9139 • E-ISSN: 1527-3350
EditorialOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1002/hep.26431
PMID23553643
PMCIDPMC3933734
OpenAlexW2115399503
IdiomaEN
Citas recibidas59
Referencias citadas50

UNLABELLED: Substantial reductions in hepatitis C virus (HCV) prevalence among people who inject drugs (PWID) cannot be achieved by harm reduction interventions such as needle exchange and opiate substitution therapy (OST) alone. Current HCV treatment is arduous and uptake is low, but new highly effective and tolerable interferon-free direct-acting antiviral (DAA) treatments could facilitate increased uptake. We projected the potential impact of DAA treatments on PWID HCV prevalence in three settings. A dynamic HCV transmission model was parameterized to three chronic HCV prevalence settings: Edinburgh, UK (25%); Melbourne, Australia (50%); and Vancouver, Canada (65%). Using realistic scenarios of future DAAs (90% sustained viral response, 12 weeks duration, available 2015), we projected the treatment rates required to reduce chronic HCV prevalence by half or three-quarters within 15 years. Current HCV treatment rates may have a minimal impact on prevalence in Melbourne and Vancouver (<2% relative reductions) but could reduce prevalence by 26% in 15 years in Edinburgh. Prevalence could halve within 15 years with treatment scale-up to 15, 40, or 76 per 1,000 PWID annually in Edinburgh, Melbourne, or Vancouver, respectively (2-, 13-, and 15-fold increases, respectively). Scale-up to 22, 54, or 98 per 1,000 PWID annually could reduce prevalence by three-quarters within 15 years. Less impact occurs with delayed scale-up, higher baseline prevalence, or shorter average injecting duration. Results are insensitive to risk heterogeneity or restricting treatment to PWID on OST. At existing HCV drug costs, halving chronic prevalence would require annual treatment budgets of US $3.2 million in Edinburgh and approximately $50 million in Melbourne and Vancouver. CONCLUSION: Interferon-free DAAs could enable increased HCV treatment uptake among PWID, which could have a major preventative impact. However, treatment costs may limit scale-up, and should be addressed.

Intensive care medicine · Scale (ratio) · Diabetes Management and Education · Hepatitis C virus research · HIV, Drug Use, Sexual Risk · Medicine · Virology