Cluster of infectious diseases, Amsterdam Public Health Service, Amsterdam, The Netherlands.
Addiction. 2012 Mar;107(3):614-23. doi: 10.1111/j.1360-0443.2011.03654.x.
The hepatitis C virus (HCV) disease burden among injecting drug users (IDUs) is determined by HCV incidence, the long latency period of HCV, competing mortality causes, presence of co-infection and HCV treatment uptake. We examined the effect of these factors and estimated the HCV disease burden in Amsterdam.
A Markov model was developed, incorporating HCV and human immunodeficiency virus (HIV), and parameterized with data from the Amsterdam Cohort Studies, surveillance studies and literature.
IDU population of Amsterdam.
HCV infection simulated from its acute phase to HCV-related liver disease (i.e. decompensated cirrhosis and hepatocellular carcinoma).
The HCV prevalence among IDUs in Amsterdam increased to approximately 80% in the 1980s. From 2011 to 2025, the HCV-related disease prevalence will accordingly rise by 36%, from 57 cases (95% range 33-94) to 78 (95% range 43-138), respectively. In total, 945 (95% range 617-1309) individuals will develop HCV-related liver disease. This burden would have been 33% higher in the absence of HIV, resulting in 1219 cases (95% range 796-1663). In Amsterdam, 25% of HIV-negative IDUs receive successful HCV treatment, reducing the cumulative disease burden by 14% to 810 (95% range 520-1120). Further reduction of 36% can be achieved by improving treatment, resulting in 603 cases (95% range 384-851).
The hepatitis C virus burden among injecting drug users in Amsterdam has been reduced by a high competing mortality rate, particularly caused by HIV infection, and to a smaller extent by hepatitis C virus treatment. Improved hepatitis C virus treatment is expected to contribute to reduce the future hepatitis C virus disease burden.
注射吸毒者（IDU）中的丙型肝炎病毒（HCV）疾病负担由 HCV 发病率、HCV 的长潜伏期、竞争死亡率原因、合并感染和 HCV 治疗的存在决定。我们检查了这些因素的影响，并估计了阿姆斯特丹的 HCV 疾病负担。
开发了一个马尔可夫模型，包含 HCV 和人类免疫缺陷病毒（HIV），并使用来自阿姆斯特丹队列研究、监测研究和文献的数据进行参数化。
阿姆斯特丹 IDU 人群。
从急性阶段模拟 HCV 感染到 HCV 相关肝病（即失代偿性肝硬化和肝细胞癌）。
20 世纪 80 年代，阿姆斯特丹 IDU 中的 HCV 流行率增加到了约 80%。从 2011 年到 2025 年，HCV 相关疾病的流行率将相应上升 36%，从 57 例（95%范围 33-94）上升到 78 例（95%范围 43-138）。共有 945 人（95%范围 617-1309）会发展为 HCV 相关肝病。如果没有 HIV，这一负担将增加 33%，导致 1219 例（95%范围 796-1663）。在阿姆斯特丹，25%的 HIV 阴性 IDU 接受成功的 HCV 治疗，使累积疾病负担减少 14%至 810 例（95%范围 520-1120）。通过改善治疗，还可以进一步减少 36%，导致 603 例（95%范围 384-851）。
阿姆斯特丹 IDU 中的 HCV 负担由于高竞争死亡率（特别是由 HIV 感染引起）而降低，由于 HCV 治疗而降低到较小程度。改进 HCV 治疗有望有助于降低未来的 HCV 疾病负担。
