Bielen Rob, Moreno Christophe, Van Vlierberghe Hans, Bourgeois Stefan, Mulkay Jean-Pierre, Vanwolleghem Thomas, Verlinden Wim, Brixko Christian, Decaestecker Jochen, De Galocsy Chantal, Janssens Filip, Cool Mike, Van Overbeke Lode, Van Steenkiste Christophe, D'heygere François, Cools Wilfried, Nevens Frederik, Robaeys Geert
Faculty of Medicine and Life Sciences, Hasselt University, Department of Gastro-Enterology and Hepatology, Ziekenhuis-Oost Limburg, Genk, Belgium.
Department of Gastro-Enterology and Hepatopancreatology, Erasme Hospital, Brussels, Belgium.
Drug Alcohol Depend. 2017 Aug 1;177:214-220. doi: 10.1016/j.drugalcdep.2017.04.003. Epub 2017 May 30.
Hepatitis C viral infection (HCV) has become a curable disease due to the development of direct acting antivirals (DAA). The WHO has set a target to eliminate HCV completely. Therefore, people who inject drugs (PWID) also need to be treated. In this study, we compared the real-life uptake and outcome of DAA treatment for HCV in PWID and non-PWID.
We performed a nation-wide, retrospective cohort study in 15 hospitals. All patients who were treated with simeprevir-sofosbuvir, daclatasvir-sofosbuvir, or ombitasvir/paritaprevir ritonavir-dasabuvir between December 2013 and November 2015 were included.
The study population consisted of 579 patients: 115 PWID (19.9%) and 464 non-PWID (80.1%). Of the PWID 18 were active PWID (15.6%), 35 still received opiate substitution therapy (OST) (30.4%) and 62 were former PWID without OST (53.9%). PWID were more infected with genotype 1a and 3 (p=0.001). There were equal rates of side-effects (44.7% vs. 46.6%; p=0.847), similar rates of treatment completion (95.7% vs 98.1%; p=0.244) and SVR (93.0% vs 94.8%; p=0.430) between PWID and non-PWID, respectively.
PWID, especially active users, are underserved for DAA treatment in real life in Belgium. Reimbursement criteria based on fibrosis stage make it difficult to treat PWID. Treatment adherence is similar in PWID and the general population, even in patients with active abuse. DAA were safe and effective in PWID despite the higher prevalence of difficult-to-treat genotypes. Based on these data more efforts to treat PWID are needed and policy changes are necessary to reach the WHO targets.
由于直接作用抗病毒药物（DAA）的发展，丙型肝炎病毒感染（HCV）已成为一种可治愈的疾病。世界卫生组织设定了完全消除HCV的目标。因此，注射吸毒者（PWID）也需要接受治疗。在本研究中，我们比较了PWID和非PWID中DAA治疗HCV的实际接受情况和治疗结果。
我们在15家医院进行了一项全国性的回顾性队列研究。纳入了2013年12月至2015年11月期间接受simeprevir-索磷布韦、达卡他韦-索磷布韦或奥比他韦/帕利哌韦/利托那韦-达沙布韦治疗的所有患者。
研究人群包括579名患者：115名PWID（19.9%）和464名非PWID（80.1%）。在PWID中，18名是现用注射吸毒者（15.6%），35名仍接受阿片类药物替代疗法（OST）（30.4%），62名是既往PWID且未接受OST（53.9%）。PWID感染1a型和3型基因型的比例更高（p = 0.001）。PWID和非PWID的副作用发生率相同（44.7%对46.6%；p = 0.847），治疗完成率相似（95.7%对98.1%；p = 0.244），持续病毒学应答率（SVR）也相似（93.0%对94.8%；p = 0.430）。
在比利时的现实生活中，PWID，尤其是现用注射吸毒者，在DAA治疗方面未得到充分服务。基于纤维化阶段的报销标准使得治疗PWID变得困难。PWID与普通人群的治疗依从性相似，即使是有药物滥用行为的患者也是如此。尽管难治基因型的患病率较高，但DAA在PWID中是安全有效的。基于这些数据，需要做出更多努力来治疗PWID，并且有必要进行政策变革以实现世界卫生组织的目标。
