Janjua Naveed Z, Darvishian Maryam, Wong Stanley, Yu Amanda, Rossi Carmine, Ramji Alnoor, Yoshida Eric M, Butt Zahid A, Samji Hasina, Chong Mei, Chapinal Nuria, Cook Darrel, Alvarez Maria, Tyndall Mark, Krajden Mel
British Columbia Centre for Disease Control Vancouver Canada.
School of Population and Public Health University of British Columbia Vancouver Canada.
Hepatol Commun. 2019 Jan 10;3(4):478-492. doi: 10.1002/hep4.1307. eCollection 2019 Apr.
We evaluated the effectiveness of ledipasvir/sofosbuvir (LDV/SOF) in treating hepatitis C virus (HCV) genotype 1 and SOF/velpatasvir (SOF/VEL) for all genotypes among people who inject drugs (PWID) and those not injecting drugs and who were on or off opioid agonist therapy (OAT). Study participants comprised a population-based cohort in British Columbia, Canada. The British Columbia Hepatitis Testers Cohort includes data on individuals tested for HCV from 1990 to 2016 that are integrated with medical visits, hospitalization, and prescription drug data. We classified study participants as off OAT/recent injection drug use (off-OAT/RIDU), off OAT/past IDU (off-OAT/PIDU), off OAT/no IDU (off-OAT/NIDU), on OAT/IDU (on-OAT/IDU), and on OAT/no IDU (on-OAT/NIDU). We assessed sustained virologic response (SVR) 10 weeks after HCV treatment among study groups treated with LDV/SOF or SOF/VEL until January 13, 2018. Analysis included 5,283 eligible participants: 390 off-OAT/RIDU, 598 off-OAT/PIDU, 3,515 off-OAT/NIDU, 609 on-OAT/IDU, and 171 on-OAT/NIDU. The majority were male patients (64%-74%) and aged ≥50 years (58%-85%). The SVRs for off-OAT/RIDU, off-OAT/PIDU, off-OAT/NIDU, on-OAT/IDU, and on-OAT/NIDU were 91% (355/390), 95% (570/598), 96% (3,360/3,515), 93% (567/609), and 95% (163/171), respectively. Among those with no SVR, 14 individuals died while on treatment or before SVR assessment, including 4 from illicit drug overdose. In the overall multivariable model, off-OAT/RIDU, on-OAT/IDU, male sex, cirrhosis, treatment duration <8 weeks, treatment duration 8 weeks, and treatment with SOF/VEL were associated with not achieving SVR. In this large real-world cohort, PWID and/or those on OAT achieved high SVRs, although slightly lower than people not injecting drugs. This finding also highlights the need for additional measures to prevent loss to follow-up and overdose-related deaths among PWID.
我们评估了来迪派韦/索磷布韦（LDV/SOF）治疗丙型肝炎病毒（HCV）1型的有效性，以及索磷布韦/维帕他韦（SOF/VEL）治疗所有基因型的有效性，研究对象为注射毒品者（PWID）以及未注射毒品者，且这些人正在接受或未接受阿片类激动剂治疗（OAT）。研究参与者来自加拿大不列颠哥伦比亚省一个基于人群的队列。不列颠哥伦比亚省肝炎检测队列包含了1990年至2016年接受HCV检测的个体数据，这些数据与医疗就诊、住院及处方药数据整合在一起。我们将研究参与者分为未接受OAT/近期注射毒品（未接受OAT/近期注射毒品组）、未接受OAT/既往注射毒品（未接受OAT/既往注射毒品组）、未接受OAT/未注射毒品（未接受OAT/未注射毒品组）、接受OAT/注射毒品（接受OAT/注射毒品组）以及接受OAT/未注射毒品（接受OAT/未注射毒品组）。我们评估了在2018年1月13日前接受LDV/SOF或SOF/VEL治疗的研究组中，HCV治疗10周后的持续病毒学应答（SVR）情况。分析纳入了5283名符合条件的参与者：390名未接受OAT/近期注射毒品组、598名未接受OAT/既往注射毒品组、3515名未接受OAT/未注射毒品组、609名接受OAT/注射毒品组以及171名接受OAT/未注射毒品组。大多数为男性患者（64% - 74%），年龄≥50岁（58% - 85%）。未接受OAT/近期注射毒品组、未接受OAT/既往注射毒品组、未接受OAT/未注射毒品组、接受OAT/注射毒品组以及接受OAT/未注射毒品组的SVR分别为91%（355/390）、95%（570/598）、96%（3360/3515）、93%（567/609）以及95%（163/171）。在未实现SVR的患者中，有14人在治疗期间或SVR评估前死亡，其中4人死于非法药物过量。在总体多变量模型中，未接受OAT/近期注射毒品组、接受OAT/注射毒品组、男性、肝硬化、治疗时长<8周、治疗时长8周以及使用SOF/VEL治疗与未实现SVR相关。在这个大型真实世界队列中，注射毒品者和/或接受OAT治疗者实现了较高的SVR，尽管略低于未注射毒品者。这一发现也凸显了采取额外措施以防止注射毒品者失访以及与过量用药相关死亡的必要性。
