Department of Infectious Diseases, Akershus University Hospital, 1478 Lørenskog, Norway.
Institute of Clinical Medicine, University of Oslo, 0371 Oslo, Norway.
Viruses. 2024 May 27;16(6):858. doi: 10.3390/v16060858.
Treatment of hepatitis C among people who inject drugs (PWID) may be complicated by loss to follow-up and reinfection. We aimed to evaluate sustained virologic response (SVR) and reinfection, and to validate complete pharmacy dispensation as a proxy for cure among PWID enrolled in a trial of opportunistic HCV treatment. Data were obtained by reviewing the electronic patient files and supplemented by outreach HCV RNA testing. Reinfection was defined based on clinical, behavioral, and virological data. Intention to treat SVR ≥ 4 within 2 years after enrolment was accomplished by 59 of 98 (60% [95% CI 50-70]) during intervention conditions (opportunistic treatment) and by 57 of 102 (56% [95% CI 46-66]) during control conditions (outpatient treatment). The time to end of treatment response (ETR) or SVR ≥ 4 was shorter among intervention participants (HR 1.55 [1.08-2.22]; = 0.016). Of participants with complete dispensation, 132 of 145 (91%) achieved ETR or SVR > 4 (OR 12.7 [95% CI 4.3-37.8]; < 0.001). Four cases of reinfection were identified (incidence 3.8/100 PY [95% CI 1.0-9.7]). Although SVR was similar, the time to virologic cure was shorter among intervention participants. Complete dispensation is a valid correlate for cure among individuals at risk of loss to follow-up. Reinfection following successful treatment remains a concern.
在注射吸毒者（PWID）中治疗丙型肝炎可能会因随访和再感染而复杂化。我们旨在评估持续病毒学应答（SVR）和再感染，并验证完全药物配给作为机会性 HCV 治疗试验中 PWID 治愈的替代指标。数据通过审查电子患者档案获得，并通过外展 HCV RNA 检测进行补充。再感染是根据临床、行为和病毒学数据定义的。在干预条件（机会性治疗）下，98 名参与者中有 59 名（60%[95%CI50-70]）在 2 年内达到了治疗意向 SVR≥4，在对照条件（门诊治疗）下，102 名参与者中有 57 名（56%[95%CI46-66]）达到了这一目标。干预组的治疗结束时的病毒学应答（EOT）或 SVR≥4 的时间更短（HR1.55[1.08-2.22]；=0.016）。在完全配给的参与者中，145 名中有 132 名（91%）达到了 EOT 或 SVR>4（OR12.7[95%CI4.3-37.8]；<0.001）。确定了 4 例再感染（发病率 3.8/100 人年[95%CI1.0-9.7]）。尽管 SVR 相似，但干预组的病毒学治愈时间更短。完全配给是对随访丢失风险个体治愈的有效相关性。成功治疗后仍存在再感染的问题。
