Nava Felice Alfonso, Mangia Alessandra, Riglietta Marco, Somaini Lorenzo, Foschi Francesco Giuseppe, Claar Ernesto, Maida Ivana, Ucciferri Claudio, Frigerio Francesca, Hernandez Candido, Dovizio Melania, Perrone Valentina, Degli Esposti Luca, Puoti Massimo
U.O. Sanità Penitenziaria e Area Dipendenze, Azienda ULSS 6 Euganea, Padova, Italy.
UOS Epatologia, Istituto di Ricovero e Cura "Casa Sollievo della Sofferenza", S. Giovanni Rotondo, Italy.
Ther Clin Risk Manag. 2023 Aug 4;19:645-656. doi: 10.2147/TCRM.S409134. eCollection 2023.
Hepatitis C virus (HCV) spreads from contact with blood of an infected person. HCV infections are common among people who use drugs (PWUDs), when sharing needles, syringes, or other equipment for injected drugs. The advent of pangenotypic direct-antiviral agents (DAA) in 2017 transformed the treatment landscape for HCV, but PWUDs remain a complex and hard-to-treat population with high risk of HCV reinfection. The aim of this real-world analysis was to characterize the demographic and clinical features of PWUDs in Italy, also focusing on comorbidity profile, treatment with DAAs, resource consumptions for the National Health System (NHS).
During 01/2011-06/2020, administrative databases of Italian healthcare entities, covering 3,900,000 individuals, were browsed to identify PWUDs with or without HCV infection. Among HCV+ patients, a further stratification was made into treated and untreated with DAAs. The date of PWUD or HCV first diagnosis or DAA first prescription was considered as index-date. Patients were then followed-up for one year. Alcohol-dependency was also investigated.
Total 3690 PWUDs were included, of whom 1141 (30.9%) PWUD-HCV+ and 2549 (69.1%) PWUD-HCV-. HCV-positive were significantly older (43.6 vs 38.5 years, p < 0.001), had a worse comorbidity profile (Charlson-index: 0.8 vs 0.4, p < 0.001), and high rates of psychiatric, respiratory, dermatological, musculoskeletal diseases and genitourinary (sexually transmitted) infections. Moreover, they received more drug prescriptions (other than DAAs, like anti-acids, antiepileptics, psycholeptics) and had undergone more frequent hospitalization, predominantly for hepatobiliary, respiratory system and mental disorders. DDA-untreated had significantly higher Charlson-index than DAA-treated (0.9 vs 0.6, p = 0.003). Alcoholism was found in 436 (11.8%) cases.
This Italian real-world analysis suggests that PWUDs with HCV infection, especially those untreated with DAAs, show an elevated drug consumption due to their complex clinical profile. These findings could help to ameliorate the healthcare interventions on PWUDs with HCV infection.
丙型肝炎病毒（HCV）通过接触感染者的血液传播。在共用针头、注射器或其他注射毒品设备的吸毒人员（PWUDs）中，HCV感染很常见。2017年泛基因型直接抗病毒药物（DAA）的出现改变了HCV的治疗格局，但PWUDs仍然是一个复杂且难以治疗的群体，HCV再感染风险很高。这项真实世界分析的目的是描述意大利PWUDs的人口统计学和临床特征，同时关注合并症情况、DAA治疗情况以及国家卫生系统（NHS）的资源消耗。
在2011年1月至2020年6月期间，浏览了涵盖390万人的意大利医疗保健机构的行政数据库，以识别有或无HCV感染的PWUDs。在HCV阳性患者中，进一步分为接受DAA治疗和未接受DAA治疗两组。将PWUD或HCV首次诊断日期或DAA首次处方日期视为索引日期。然后对患者进行一年的随访。还对酒精依赖情况进行了调查。
共纳入3690名PWUDs，其中1141名（30.9%）为PWUD-HCV阳性，2549名（69.1%）为PWUD-HCV阴性。HCV阳性患者年龄显著更大（43.6岁对38.5岁，p<0.001），合并症情况更差（Charlson指数：0.8对0.4，p<0.001），精神、呼吸、皮肤、肌肉骨骼疾病和泌尿生殖系统（性传播）感染的发生率更高。此外，他们接受的药物处方（除DAA外，如抗酸药、抗癫痫药、精神药物）更多，住院频率更高，主要是因为肝胆、呼吸系统和精神疾病。未接受DAA治疗的患者Charlson指数显著高于接受DAA治疗的患者（0.9对0.6，p=0.003）。436例（11.8%）发现有酒精中毒。
这项意大利的真实世界分析表明，HCV感染的PWUDs，尤其是那些未接受DAA治疗的患者，由于其复杂的临床情况，药物消耗量较高。这些发现有助于改善对HCV感染的PWUDs的医疗干预。
