Alimohammadi Arshia, Holeksa Julie, Thiam Astou, Truong David, Conway Brian
Vancouver Infectious Diseases Centre, Vancouver, British Columbia, Canada.
Open Forum Infect Dis. 2018 May 23;5(6):ofy120. doi: 10.1093/ofid/ofy120. eCollection 2018 Jun.
Many clinicians and insurance providers are reluctant to embrace recent guidelines identifying people who inject drugs (PWID) as a priority population to receive hepatitis C virus (HCV) treatment. The aim of this study was to evaluate the efficacy of direct-acting antiviral (DAA) HCV therapy in a real-world population comprised predominantly of PWID.
A retrospective analysis was performed on all HCV-infected patients who were treated at the Vancouver Infectious Diseases Centre between March 2014 and December 2017. All subjects were enrolled in a multidisciplinary model of care, addressing medical, psychological, social, and addiction-related needs. The primary outcome was achievement of sustained virologic response (undetectable HCV RNA) 12 or more weeks after completion of HCV therapy (SVR-12).
Overall, 291 individuals were enrolled and received interferon-free DAA HCV therapy. The mean age was 54 years, 88% were PWID, and 20% were HCV treatment experienced. At data lock, 62 individuals were still on treatment and 229 were eligible for evaluation of SVR by intent-to-treat (ITT) analysis. Overall, 207 individuals achieved SVR (90%), with 13 losses to follow-up, 7 relapses, and 2 premature treatment discontinuations. ITT SVR analysis show that active PWID and treatment-naïve patients were less likely to achieve SVR ( = .0185 and .0317, respectively). Modified ITT analysis of active PWID showed no difference in achieving SVR ( = .1157) compared with non-PWID.
Within a multidisciplinary model of care, the treatment of HCV-infected PWID with all-oral DAA regimens is safe and highly effective. These data justify targeted efforts to enhance access to HCV treatment in this vulnerable and marginalized population.
许多临床医生和保险机构不愿采用近期指南，该指南将注射吸毒者（PWID）列为接受丙型肝炎病毒（HCV）治疗的优先人群。本研究的目的是评估直接抗病毒药物（DAA）治疗HCV在以PWID为主的真实世界人群中的疗效。
对2014年3月至2017年12月在温哥华传染病中心接受治疗的所有HCV感染患者进行回顾性分析。所有受试者均纳入多学科护理模式，以满足医疗、心理、社会和成瘾相关需求。主要结局是HCV治疗完成后12周或更长时间达到持续病毒学应答（HCV RNA检测不到）（SVR-12）。
总体而言，291人入组并接受了不含干扰素的DAA HCV治疗。平均年龄为54岁，88%为PWID，20%有HCV治疗史。在数据锁定时，62人仍在接受治疗，229人符合意向性分析（ITT）评估SVR的条件。总体而言，207人实现了SVR（90%），13人失访，7人复发，2人提前终止治疗。ITT SVR分析显示，活跃的PWID和初治患者实现SVR的可能性较小（分别为P = 0.0185和P = 0.0317）。对活跃的PWID进行的改良ITT分析显示，与非PWID相比，实现SVR无差异（P = 0.1157）。
在多学科护理模式下，采用全口服DAA方案治疗HCV感染的PWID是安全且高效的。这些数据证明有针对性地努力增加这一脆弱和边缘化人群获得HCV治疗的机会是合理的。
