Černoša Jasna, Volkar Jelka Meglič, Poljak Mario, Perme Maja Pohar, Lazarus Jeffrey Victor, Matičič Mojca
Clinic for Infectious Diseases and Febrile Illnesses, University Medical Centre Ljubljana, Ljubljana, Slovenia.
Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
Harm Reduct J. 2025 Feb 13;22(1):16. doi: 10.1186/s12954-025-01164-5.
Hepatitis C virus (HCV) infection remains a public health threat. Although therapy with direct-acting antivirals made its elimination possible, major challenges remain in treating vulnerable populations, such as people who inject drugs (PWID) enrolled in low-threshold programmes (LTPs). This study analysed the outcome of HCV management focused on HCV reinfection in a specifically designed model-of-care (MoC) for PWID in Slovenia, where treatment is prescribed without limitations, though only by specialist physicians.
All HCV antibody (anti-HCV) positive users of a MoC, combining HCV management at Clinic for Infectious Diseases at the University Medical Centre in Ljubljana and LTP for PWID in 100 km distanced civil society organisation (CSO) Svit Koper, between January 2017 to December 2022, were included. The MoC enabled regular transportation of PWID between LTP and the Clinic, where specifically assigned services for individually tailored HCV management in cooperation with CSO were available. Data on participants´ demographic, epidemiological, and clinical characteristics were collected partly retrospectively and prospectively, with a particular focus on HCV treatment outcome and reinfection status, and analysed accordingly.
The study included 49 anti-HCV positive PWID with a mean age of 38.7 (standard deviation (SD) = 7.6) years at first visit. The majority was male (40/49, 81.6%); 16/49 (32.7%) experienced previous incarceration, 14/49 (28.6%) were experiencing homelessness, and 42/49 (85.7%) were receiving opioid agonist therapy. A total of 42/49 (83.7%) were HCV RNA-positive. Of them 36/42 (85.7%) started HCV treatment at a mean age of 42.7 (SD = 5.7) years and 33/36 (91.7%) completed treatment. Six (14.3%) HCV RNA-positive PWID died. Among 28/33 (84.9%) who achieved a sustained virological response 12 weeks post treatment, 6/28 (21.4%) presented with reinfection. The HCV reinfection rate was 13.3 per 100 - PY (95% confidence interval (CI) [6.0, 29.7]), the rate of positive HCV RNA re-test was 12.2 per 100 - PY (95%CI [7.7-16.7]), while hazard of reinfection in our cohort increased with time, with the estimated reinfection probability exceeding 0.5 at 4 years.
In marginalised population of PWID attending LTP, a sustainable HCV RNA re-screening and follow-up after HCV cure are necessary, as the risk of reinfection remains high.
丙型肝炎病毒（HCV）感染仍然是一项公共卫生威胁。尽管直接抗病毒药物治疗使其消除成为可能，但在治疗弱势群体时仍面临重大挑战，例如参与低门槛项目（LTPs）的注射吸毒者（PWID）。本研究分析了在斯洛文尼亚为PWID专门设计的护理模式（MoC）中，以HCV再感染为重点的HCV管理结果，在该模式中，治疗由专科医生无限制地开具处方。
纳入2017年1月至2022年12月期间，在卢布尔雅那大学医学中心传染病诊所进行HCV管理，并在距离100公里的民间社会组织（CSO）斯维特科佩尔为PWID提供LTP的MoC的所有HCV抗体（抗-HCV）阳性使用者。该MoC使得PWID能够在LTP和诊所之间定期转运，在诊所与CSO合作可为其提供针对个体定制的HCV管理的特定服务。部分回顾性和前瞻性地收集了参与者的人口统计学、流行病学和临床特征数据，特别关注HCV治疗结果和再感染状态，并据此进行分析。
该研究纳入了49名抗-HCV阳性的PWID，首次就诊时平均年龄为38.7（标准差（SD）=7.6）岁。大多数为男性（40/49，81.6%）；16/49（32.7%）曾有入狱经历，14/49（28.6%）无家可归，42/49（85.7%）接受阿片类激动剂治疗。共有42/49（83.7%）为HCV RNA阳性。其中36/42（85.7%）在平均年龄42.7（SD=5.7）岁时开始HCV治疗，33/36（91.7%）完成治疗。6名（14.3%）HCV RNA阳性的PWID死亡。在治疗后12周实现持续病毒学应答的28/33（84.9%）人中，6/28（21.4%）出现再感染。HCV再感染率为每100人年13.3例（95%置信区间（CI）[6.0, 29.7]），HCV RNA重新检测阳性率为每100人年12.2例（95%CI [7.7 - 16.7]），而我们队列中的再感染风险随时间增加，估计4年后再感染概率超过0.5。
在参与LTP的PWID这一边缘化人群中，HCV治愈后进行可持续的HCV RNA重新筛查和随访是必要的，因为再感染风险仍然很高。
