The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
University at Buffalo, Buffalo, New York, USA.
J Viral Hepat. 2024 Jun;31(6):342-356. doi: 10.1111/jvh.13927. Epub 2024 Mar 3.
All-oral, direct-acting antivirals can cure hepatitis C virus (HCV) in almost all infected individuals; yet, many individuals with chronic HCV are not treated, and the incidence of acute HCV is increasing in some countries, including the United States. Strains on healthcare resources during the COVID-19 pandemic negatively impacted the progress toward the World Health Organization goal to eliminate HCV by 2030, especially among persons who inject drugs (PWID). Here, we present a holistic conceptual framework termed LOTUS (Leveraging Opportunities for Treatment/User Simplicity), designed to integrate the current HCV practice landscape and invigorate HCV treatment programs in the setting of endemic COVID-19: (A) treatment as prevention (especially among PWID), (B) recognition that HCV cure may be achieved with variable adherence with evidence supporting some forgiveness for missed doses, (C) treatment of all persons with active HCV infection (viremic), regardless of acuity, (D) minimal monitoring (MinMon) during treatment, and (E) rapid test and treat (TnT). The objective of this article is to review the current literature supporting each LOTUS petal; identify remaining gaps in knowledge or data; define the remaining barriers facing healthcare providers; and review evidence-based strategies for overcoming key barriers.
所有口服、直接作用的抗病毒药物几乎可以治愈所有感染 HCV 病毒的个体；然而，许多慢性 HCV 患者未得到治疗，包括美国在内的一些国家的急性 HCV 发病率正在上升。在 COVID-19 大流行期间，医疗资源紧张，这对实现世界卫生组织到 2030 年消除 HCV 的目标产生了负面影响，特别是在注射毒品者（PWID）中。在这里，我们提出了一个整体概念框架，称为 LOTUS（利用治疗机会和用户简便性），旨在整合当前 HCV 治疗实践的现状，并在地方性 COVID-19 背景下激活 HCV 治疗计划：（A）治疗即预防（特别是在 PWID 中），（B）认识到 HCV 可以通过不同的治疗依从性来治愈，证据支持对错过剂量的一些宽容，（C）治疗所有有活性 HCV 感染（病毒血症）的个体，无论严重程度如何，（D）治疗期间进行最小监测（MinMon），（E）快速检测和治疗（TnT）。本文的目的是回顾支持每个 LOTUS 花瓣的现有文献；确定知识或数据方面仍然存在的差距；定义医疗保健提供者面临的剩余障碍；并审查克服关键障碍的循证策略。
