Erschienen in:
Journal of Viral Hepatitis, 26 (2019) 5, Seite 519-528
Sprache:
Englisch
DOI:
10.1111/jvh.13035
ISSN:
1365-2893;
1352-0504
Entstehung:
Anmerkungen:
Beschreibung:
<jats:title>Summary</jats:title><jats:p>To achieve <jats:styled-content style="fixed-case">WHO</jats:styled-content> hepatitis C virus (<jats:styled-content style="fixed-case">HCV</jats:styled-content>) elimination targets by 2030, mathematical models suggest there needs to be significant scale‐up of treatment among people who inject drugs (<jats:styled-content style="fixed-case">PWID</jats:styled-content>). We tested whether people who actively inject drugs can be recruited and treated successfully through a community needle and syringe programme (<jats:styled-content style="fixed-case">NSP</jats:styled-content>), and assessed rates of re‐infection. 105 <jats:styled-content style="fixed-case">HCV RNA</jats:styled-content> positive participants were enrolled prospectively. Participants were recruited from the largest <jats:styled-content style="fixed-case">NSP</jats:styled-content> in Dundee over 42 months. 94/105 individuals commenced treatment. Genotype 1 (G1) individuals (n = 37) were treated with peg‐interferon+ribavirin+Simepravir/Telaprevir. Genotype 2/3 (G2/3) (n = 57) received peg‐interferon+ribavirin. Weekly study visits took place within the <jats:styled-content style="fixed-case">NSP</jats:styled-content>. Mean age of participants was 34.0 years (<jats:styled-content style="fixed-case">SD</jats:styled-content> 6.9), 71.3% (61/94) were male. One in five (20/94) participants were homeless. 68.1% (64/94) were on <jats:styled-content style="fixed-case">OST</jats:styled-content> (opiate substitution therapy) at enrolment; participants injected median 6.5 times/wk. In terms of clinical outcomes, >80% treatment adherence was 71.3% (67/94). There was no difference in <jats:styled-content style="fixed-case">SVR</jats:styled-content>‐12 rates by genotype: 81.0% (30/37) for G1 and 82.5% (47/55) for G2/3. At 18 months post‐treatment, 15/77 participants were reinfected, followed up over 69.8 person‐years, yielding a re‐infection rate of 21.5/100 person‐years (95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 13.00‐35.65). This trial demonstrates that <jats:styled-content style="fixed-case">HCV</jats:styled-content> treatment can be delivered successfully to the target population of treatment as prevention strategies. We report higher rates of re‐infection than existing estimates among <jats:styled-content style="fixed-case">PWID</jats:styled-content>. Scale‐up of <jats:styled-content style="fixed-case">HCV</jats:styled-content> treatment should be pursued alongside a comprehensive programme of harm reduction interventions to help minimize re‐infection and reduce <jats:styled-content style="fixed-case">HCV</jats:styled-content> transmission.</jats:p>