Martinello Marianne, Hajarizadeh Behzad, Grebely Jason, Dore Gregory J, Matthews Gail V
Viral Hepatitis Clinical Research Program, Kirby Institute, UNSW Australia, Wallace Wurth Building, Sydney, NSW, 2052, Australia.
St Vincent's Hospital, Sydney, NSW, Australia.
Curr HIV/AIDS Rep. 2017 Jun;14(3):110-121. doi: 10.1007/s11904-017-0358-8.
Highly effective, well-tolerated interferon-free direct-acting antivirals (DAA) have revolutionised hepatitis C virus (HCV) therapeutics, with the opportunity for broad treatment scale-up among marginalised or "high-risk" populations, including people who inject drugs (PWID) and people with HIV/HCV coinfection.
Concern that HCV reinfection may compromise HCV treatment outcomes is sometimes cited as a reason for not offering treatment to current and former PWID. However, the incidence of reinfection following interferon-based treatment for chronic HCV is low among PWID. Reinfection rates in HIV-positive men-who-have-sex-with-men (MSM) are varied, with high incidence reported in some cohorts. Mathematical modelling suggests that substantial reductions in HCV incidence and prevalence could be achieved with targeted DAA therapy among those at the highest risk of ongoing transmission. This review will summarise the recent literature on DAA efficacy in PWID and people with HIV/HCV coinfection, discuss the individual- and population-level impact of DAA treatment scale-up and reinfection, and highlight ongoing and future research questions in expanding HCV care and treatment to those populations at high risk of ongoing HCV transmission.
高效、耐受性良好的无干扰素直接抗病毒药物（DAA）彻底改变了丙型肝炎病毒（HCV）的治疗方法，为在包括注射吸毒者（PWID）和HIV/HCV合并感染者在内的边缘化或“高危”人群中广泛扩大治疗提供了机会。
有人担心HCV再次感染可能会影响HCV治疗效果，这有时被作为不给现有的和曾经的注射吸毒者提供治疗的一个理由。然而，在注射吸毒者中，基于干扰素治疗慢性HCV后的再次感染发生率较低。HIV阳性的男男性行为者（MSM）中的再次感染率各不相同，一些队列报告的发生率较高。数学模型表明，通过对持续传播风险最高的人群进行有针对性的DAA治疗，可以大幅降低HCV的发病率和流行率。本综述将总结最近关于DAA在注射吸毒者和HIV/HCV合并感染者中的疗效的文献，讨论扩大DAA治疗规模和再次感染对个人和人群层面的影响，并强调在将HCV护理和治疗扩展到那些有持续HCV传播高风险的人群方面正在进行的和未来的研究问题。
