Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh.
British Columbia Centre for Disease Control, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC Canada; CIHR Canadian HIV Trials Network, Vancouver, BC Canada.
Int J Drug Policy. 2019 Dec;74:69-75. doi: 10.1016/j.drugpo.2019.09.002. Epub 2019 Sep 19.
Given the considerable social marginalization experienced by people who inject drugs (PWID), treatment of hepatitis C virus (HCV) in this population presents unique challenges. This study assessed the feasibility of treating HCV infection with direct-acting antiviral (DAA) medications among PWID receiving harm reduction services from a Drop-in-Center in Dhaka, Bangladesh.
In this prospective study conducted between December 2016 and May 2018, 200 PWID with either recent injecting drug use (i.e., within the previous two months) or a history of injecting drug use and are currently receiving opioid substitution therapy were recruited. Blood was collected to conduct relevant laboratory tests. Eligible PWID who tested positive for HCV RNA (n = 55), were provided daily daclatasvir (60 mg) and sofosbuvir (400 mg) for 12 weeks after which adherence level, sustained virologic response (SVR), and reinfection were assessed.
At baseline, 40% (n = 79) of the 200 participants recruited to the study tested positive for antibodies to HCV and 34% (n = 68) had detectable HCV RNA in their blood. Of 55 eligible PWID who initiated treatment, 93% (n = 51) completed treatment while 87% (n = 48) were available for follow-up SVR assessment, all of whom achieved SVR. Thus, intent-to-treat SVR was 87% and the modified intent-to-treat SVR was 100% with one reinfection (4•2 cases per 100 person-years). Further, 75% (i.e., 41 out of the 55 participants) were at least 90% adherent to therapy.
Our findings strongly suggest that HCV treatment using sofosbuvir+daclatasvir for PWID enrolled in existing harm reduction programs in Bangladesh is feasible but may require additional interventions such as Opioid Substitution Therapy, intense follow up by outreach workers, and services and counselling provided by full time clinicians.
鉴于注射吸毒者（PWID）经历了相当大的社会边缘化，在该人群中治疗丙型肝炎病毒（HCV）存在独特的挑战。本研究评估了在孟加拉国达卡的一个吸毒者收容所接受减少伤害服务的 PWID 中，使用直接作用抗病毒（DAA）药物治疗 HCV 感染的可行性。
在这项于 2016 年 12 月至 2018 年 5 月期间进行的前瞻性研究中，招募了 200 名近期（即在过去两个月内）有注射吸毒史或目前正在接受阿片类药物替代治疗的有注射吸毒史的 PWID。采集血液进行相关实验室检查。检测到 HCV RNA 阳性的符合条件的 PWID（n=55），给予每日达拉他韦（60mg）和索非布韦（400mg）治疗 12 周，然后评估依从性水平、持续病毒学应答（SVR）和再感染情况。
在基线时，研究招募的 200 名参与者中，40%（n=79）检测到 HCV 抗体阳性，34%（n=68）血液中可检测到 HCV RNA。在 55 名符合条件开始治疗的 PWID 中，93%（n=51）完成了治疗，87%（n=48）可进行随访 SVR 评估，他们均达到了 SVR。因此，意向治疗 SVR 为 87%，修改意向治疗 SVR 为 100%，发生 1 例再感染（每 100 人年 4.2 例）。此外，75%（即 55 名参与者中的 41 名）对治疗的依从性至少为 90%。
我们的研究结果强烈表明，在孟加拉国现有的减少伤害项目中，对纳入的 PWID 使用索非布韦+达拉他韦治疗 HCV 是可行的，但可能需要额外的干预措施，如阿片类药物替代治疗、由外展工作人员进行强化随访、以及由全职临床医生提供的服务和咨询。
