The Kirby Institute, UNSW Sydney, Sydney, New South Wales 2052, Australia.
Nat Rev Gastroenterol Hepatol. 2017 Nov;14(11):641-651. doi: 10.1038/nrgastro.2017.106. Epub 2017 Aug 23.
Globally, 12 million people are estimated to have injected drugs in the past year, 50% of whom have chronic HCV infection, with people who have previously injected drugs presenting an additional large reservoir of infection. The availability of simple and tolerable interferon-free direct-acting antiviral agents (DAAs) for HCV infection, which have a cure rate of >95% represents one of the most exciting advances in clinical medicine in the past few decades. Adherence and response to DAA therapy among people who inject drugs (PWID) receiving opioid substitution therapy (OST) in clinical trials are comparable to populations without a history of injecting drugs. Further data are required among current PWID not receiving OST. Given the potential prevention benefits of treatment, DAAs have enhanced cost-effectiveness among PWID. As HCV therapy is expanded to populations of PWID with high-risk behaviours for re-exposure, acknowledgement that HCV reinfection will occur is crucial, and appropriate strategies must be in place to maximize prevention of reinfection and offer retreatment for reinfection. This Review will also discuss essential components for broadening access to HCV care for PWID as we strive for the global elimination of HCV infection.
全球范围内，估计有 1200 万人在过去一年中注射过毒品，其中 50%患有慢性 HCV 感染，而曾经注射过毒品的人则存在更大的感染储备。对于 HCV 感染，简单且耐受的无干扰素直接作用抗病毒药物（DAAs）的出现代表了过去几十年临床医学中最令人兴奋的进展之一。临床试验中接受阿片类药物替代疗法（OST）的注射吸毒者（PWID）对 DAA 治疗的依从性和反应与没有注射吸毒史的人群相当。在目前未接受 OST 的当前 PWID 中需要进一步的数据。鉴于治疗的潜在预防益处，DAAs 在 PWID 中的成本效益更高。随着 HCV 治疗扩展到具有再次暴露高风险行为的 PWID 人群，承认 HCV 再感染将会发生至关重要，必须制定适当的策略来最大限度地预防再感染，并为再感染提供重新治疗。本综述还将讨论扩大 PWID 获得 HCV 护理的基本内容，因为我们努力实现全球消除 HCV 感染。
