The Kirby Institute, Faculty of Medicine, UNSW Sydney, Australia.
The Kirby Institute, Faculty of Medicine, UNSW Sydney, Australia.
J Hepatol. 2019 Jan;70(1):33-39. doi: 10.1016/j.jhep.2018.09.030. Epub 2018 Oct 25.
BACKGROUND & AIMS: The World Health Organization (WHO) established targets to eliminate hepatitis C virus (HCV) infection as a public health threat by 2030. Evidence that HCV treatment can lower viraemic prevalence among people who inject drugs (PWID) is limited. Broad accessibility of direct-acting antiviral (DAA) therapy in Australia, since March 2016, provides an opportunity to assess the efficacy of these treatments at a population level in a real-world setting.
Data from Australia's annual bio-behavioural surveillance examined treatment uptake and estimated viraemic prevalence among PWID attending needle syringe programs nationally between 2015 and 2017. Multivariate logistic regression identified variables independently associated with HCV treatment among those considered eligible (anti-HCV positive excluding HCV RNA negative with no self-reported history of HCV treatment) in 2017.
Annual samples ranged from 1,995-2,380 PWID. Anti-HCV prevalence declined from 57% (2015) to 49% (2017, χp trend <0.001), with 40-56% of anti-HCV positive respondents providing sufficient sample for HCV RNA testing. Between 2015 and 2017, treatment uptake among those eligible increased from 10% to 41% (χp trend <0.001) and viraemic prevalence among the overall sample declined from 43% to 25% (χp trend <0.001). In multivariable analysis, older age (≥50 years adjusted odds ratio [aOR] 1.82; 95% CI 1.09-3.06;p = 0.023 and 44-49 years aOR 1.75; 95% CI 1.03-3.00;p = 0.038 vs. ≤37 years) and history of opioid substitution therapy (aOR 2.06; 95% CI 1.30-3.26; p = 0.002) were independently associated with treatment.
This study confirms PWID are willing to initiate treatment when HCV DAA therapy is available and provides population-level evidence of a decline in viraemic prevalence among people most at risk of ongoing HCV transmission. Scaled up surveillance and monitoring are required to evaluate progress toward WHO HCV elimination goals.
The World Health Organization's goal to reduce hepatitis C virus incidence by 80% will be difficult to achieve without widespread scale up and a corresponding reduction in viraemic prevalence among those most at risk of onward transmission. Our results indicate that a population-level reduction in viraemic prevalence is achievable through high levels of treatment and cure among people who inject drugs.
世界卫生组织（WHO）设定了目标，要在 2030 年前消除丙型肝炎病毒（HCV）感染这一公共卫生威胁。有证据表明，HCV 治疗可以降低注射吸毒者（PWID）中的病毒血症流行率，但证据有限。自 2016 年 3 月以来，澳大利亚广泛提供直接作用抗病毒（DAA）治疗，为在真实环境中评估这些治疗在人群层面上的疗效提供了机会。
澳大利亚年度生物行为监测的数据检查了 2015 年至 2017 年期间全国参加针具交换计划的 PWID 的治疗情况，并估计了他们的病毒血症流行率。多变量逻辑回归确定了 2017 年被认为符合条件（抗 HCV 阳性，HCV RNA 阴性，无 HCV 治疗史）的 HCV 治疗中与 HCV 治疗独立相关的变量。
每年的样本范围为 1995-2380 名 PWID。抗 HCV 流行率从 57%（2015 年）下降到 49%（2017 年，χp 趋势<0.001），40-56%的抗 HCV 阳性受访者提供了足够的 HCV RNA 检测样本。2015 年至 2017 年间，符合条件者的治疗率从 10%增加到 41%（χp 趋势<0.001），总体样本的病毒血症流行率从 43%下降到 25%（χp 趋势<0.001）。多变量分析显示，年龄较大（≥50 岁的调整优势比 [aOR] 1.82；95%CI 1.09-3.06;p=0.023 和 44-49 岁 aOR 1.75；95%CI 1.03-3.00;p=0.038 vs. ≤37 岁）和阿片类药物替代疗法史（aOR 2.06；95%CI 1.30-3.26;p=0.002）与治疗独立相关。
本研究证实，当 HCV DAA 治疗可用时，PWID 愿意开始治疗，并提供了人群层面的证据，表明最易发生 HCV 持续传播的人群中病毒血症流行率有所下降。需要扩大监测和监测，以评估实现世卫组织 HCV 消除目标的进展情况。
本研究证实，当 HCV DAA 治疗可用时，PWID 愿意开始治疗，并提供了人群层面的证据，表明最易发生 HCV 持续传播的人群中病毒血症流行率有所下降。需要扩大监测和监测，以评估实现世卫组织 HCV 消除目标的进展情况。
