Conway Brian, Smyth Dan, Thomas Réjean, Wong Alex, Sebastiani Giada, Cooper Curtis, Shah Hemant, Kumar Ritesh, Deutsch Gretty, Watson Ted
Vancouver Infectious Diseases Centre, Vancouver, British Columbia, Canada.
Centre for Research, Education and Clinical Care of At-Risk Populations (RECAP), Moncton, New Brunswick, Canada.
Can Liver J. 2021 Nov 11;4(4):346-359. doi: 10.3138/canlivj-2021-0005. eCollection 2021 Fall.
Development of robust treatment programs among core transmitters (CT) of hepatitis C virus (HCV) are needed, including strategies to address reinfection risk. The aim of this study was to describe the effectiveness of direct-acting antiviral (DAA) treatment in CT versus non-CT populations and assess reinfection rates after successful treatment.
Characterizing Risk Behaviour and Reinfection Rates for Successful Programs to Engage Core Transmitters in HCV Elimination (C-RESPECT) was a prospective, observational study of HCV-infected Canadian adult patients (genotypes 1, 3, and 4) treated with DAAs between 2017 and 2020.
The full analysis set included 429 participants (259 CT, 170 non-CT). Key differences were observed in baseline profiles: CT participants were younger (mean 42.3 [SD 11.2] y versus 55.0 [SD 11.1] y, respectively) and reported higher rates of social assistance (35.7% versus 14.8%), smoking (83.7% versus 52.4%), low socioeconomic status (yearly income <$15,000: 69.6% versus 43.9%), illicit drug use (83.7% versus 34.3%), and previous incarcerations (62.7% versus 36.9%). DAA treatment adherence was similar; 93 .5% versus 98.3% of CT versus non-CT participants completed the assigned treatment duration. Cure rates (sustained virologic response) were comparable, ranging from 94.9% to 98.1%. All reinfections were among CT participants, with a rate of 13.8/100 person-years (95% CI 9.2-20.8) with mean time to reinfection of 24.6 (SD 0.6) months.
CT and non-CT participants respond equally well to DAA treatment; however, with some reinfections among CT participants. Innovative multidisciplinary programs must be developed to mitigate this risk in this key population.
需要在丙型肝炎病毒（HCV）的核心传播者（CT）中制定强有力的治疗方案，包括应对再感染风险的策略。本研究的目的是描述直接抗病毒药物（DAA）治疗在CT人群与非CT人群中的有效性，并评估成功治疗后的再感染率。
“成功项目中核心传播者参与丙型肝炎病毒消除的风险行为和再感染率特征研究（C-RESPECT）”是一项对2017年至2020年间接受DAA治疗的加拿大HCV感染成年患者（基因型1、3和4）进行的前瞻性观察性研究。
完整分析集包括429名参与者（259名CT，170名非CT）。在基线特征方面观察到关键差异：CT参与者更年轻（平均年龄分别为42.3[标准差11.2]岁和55.0[标准差11.1]岁），报告的社会救助率更高（35.7%对14.8%）、吸烟率更高（83.7%对52.4%）、社会经济地位低（年收入<$15,000：69.6%对43.9%）、非法药物使用率更高（83.7%对34.3%）以及既往监禁率更高（62.7%对36.9%）。DAA治疗的依从性相似；CT参与者与非CT参与者中分别有93.5%和98.3%完成了指定的治疗疗程。治愈率（持续病毒学应答）相当，范围为94.9%至98.1%。所有再感染均发生在CT参与者中，再感染率为13.8/100人年（95%CI 9.2-20.8），再感染的平均时间为24.6（标准差0.6）个月。
CT参与者和非CT参与者对DAA治疗的反应同样良好；然而，CT参与者中存在一些再感染情况。必须制定创新的多学科方案以降低这一关键人群中的这种风险。
