Association between rapid utilisation of direct hepatitis C antivirals and decline in the prevalence of viremia among people who inject drugs in Australia.
Adult
Antiviral Agents
/ administration & dosage
Australia
/ epidemiology
Blotting, Western
Cross-Sectional Studies
Drug Utilization
/ statistics & numerical data
Enzyme-Linked Immunosorbent Assay
Female
Hepacivirus
/ genetics
Hepatitis C Antibodies
/ analysis
Hepatitis C, Chronic
/ drug therapy
Humans
Incidence
Injections
Male
Middle Aged
Prevalence
Prognosis
Public Health
RNA, Viral
/ analysis
Retrospective Studies
Viremia
/ epidemiology
Direct-acting antivirals
Elimination
Hepatitis C virus
People who inject drugs
Treatment as prevention
Journal
Journal of hepatology
ISSN: 1600-0641
Titre abrégé: J Hepatol
Pays: Netherlands
ID NLM: 8503886
Informations de publication
Date de publication:
01 2019
01 2019
Historique:
received:
15
11
2017
revised:
04
07
2018
accepted:
24
09
2018
pubmed:
28
10
2018
medline:
22
4
2020
entrez:
28
10
2018
Statut:
ppublish
Résumé
The World Health Organization (WHO) established targets to eliminate hepatitis C virus (HCV) infection as a public health threat by 2030. Evidence that HCV treatment can lower viraemic prevalence among people who inject drugs (PWID) is limited. Broad accessibility of direct-acting antiviral (DAA) therapy in Australia, since March 2016, provides an opportunity to assess the efficacy of these treatments at a population level in a real-world setting. Data from Australia's annual bio-behavioural surveillance examined treatment uptake and estimated viraemic prevalence among PWID attending needle syringe programs nationally between 2015 and 2017. Multivariate logistic regression identified variables independently associated with HCV treatment among those considered eligible (anti-HCV positive excluding HCV RNA negative with no self-reported history of HCV treatment) in 2017. Annual samples ranged from 1,995-2,380 PWID. Anti-HCV prevalence declined from 57% (2015) to 49% (2017, χ This study confirms PWID are willing to initiate treatment when HCV DAA therapy is available and provides population-level evidence of a decline in viraemic prevalence among people most at risk of ongoing HCV transmission. Scaled up surveillance and monitoring are required to evaluate progress toward WHO HCV elimination goals. The World Health Organization's goal to reduce hepatitis C virus incidence by 80% will be difficult to achieve without widespread scale up and a corresponding reduction in viraemic prevalence among those most at risk of onward transmission. Our results indicate that a population-level reduction in viraemic prevalence is achievable through high levels of treatment and cure among people who inject drugs.
Sections du résumé
BACKGROUND & AIMS
The World Health Organization (WHO) established targets to eliminate hepatitis C virus (HCV) infection as a public health threat by 2030. Evidence that HCV treatment can lower viraemic prevalence among people who inject drugs (PWID) is limited. Broad accessibility of direct-acting antiviral (DAA) therapy in Australia, since March 2016, provides an opportunity to assess the efficacy of these treatments at a population level in a real-world setting.
METHODS
Data from Australia's annual bio-behavioural surveillance examined treatment uptake and estimated viraemic prevalence among PWID attending needle syringe programs nationally between 2015 and 2017. Multivariate logistic regression identified variables independently associated with HCV treatment among those considered eligible (anti-HCV positive excluding HCV RNA negative with no self-reported history of HCV treatment) in 2017.
RESULTS
Annual samples ranged from 1,995-2,380 PWID. Anti-HCV prevalence declined from 57% (2015) to 49% (2017, χ
CONCLUSIONS
This study confirms PWID are willing to initiate treatment when HCV DAA therapy is available and provides population-level evidence of a decline in viraemic prevalence among people most at risk of ongoing HCV transmission. Scaled up surveillance and monitoring are required to evaluate progress toward WHO HCV elimination goals.
LAY SUMMARY
The World Health Organization's goal to reduce hepatitis C virus incidence by 80% will be difficult to achieve without widespread scale up and a corresponding reduction in viraemic prevalence among those most at risk of onward transmission. Our results indicate that a population-level reduction in viraemic prevalence is achievable through high levels of treatment and cure among people who inject drugs.
Identifiants
pubmed: 30367897
pii: S0168-8278(18)32494-2
doi: 10.1016/j.jhep.2018.09.030
pii:
doi:
Substances chimiques
Antiviral Agents
0
Hepatitis C Antibodies
0
RNA, Viral
0
Types de publication
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
33-39Informations de copyright
Copyright © 2018 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.