Can antiviral therapy for Hepatitis C reduce the prevalence of HCV among injecting drug user populations? A modeling analysis of its prevention utility.


Martin, NK; Vickerman, P; Foster, GR; Hutchinson, SJ; Goldberg, DJ; Hickman, M; (2011) Can antiviral therapy for Hepatitis C reduce the prevalence of HCV among injecting drug user populations? A modeling analysis of its prevention utility. Journal of hepatology, 54 (6). pp. 1137-44. ISSN 0168-8278 DOI: https://doi.org/10.1016/j.jhep.2010.08.029

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Abstract

BACKGROUND & AIMS: Hepatitis C virus antiviral treatment is effective for individual patients but few active injecting drug users are treated. We considered the utility of antiviral treatment for primary prevention of hepatitis C.<br/> METHODS: A hepatitis C transmission model among injecting drug users was developed, incorporating treatment (62.5% average sustained viral response) with no retreatment after initial treatment failure, potential re-infection for those cured, equal genotype setting (genotype 1:genotype 2/3), and no immunity. In addition, we examined scenarios with varied treatment response rates, immunity, or retreatment of treatment failures.<br/> RESULTS: In the baseline scenario, annually treating 10 infections per 1000 injecting drug users results in a relative decrease in hepatitis C prevalence over 10 years of 31%, 13%, or 7% for baseline (untreated endemic chronic infection) prevalences of 20%, 40%, or 60%, respectively. Sensitivity analyses show that including the potential for immunity has minimal effect on the predictions; prevalence reductions remain even if SVR is assumed to be 25% lower among active IDU than current evidence suggests; retreatment of treatment failures does not alter the short-term (<5 years) projections, but does increase treatment gains within 20 years; hepatitis C free life years gained from treating active injecting drug users are projected to be higher than from treating non-injecting drug users for prevalences below 60%.<br/> CONCLUSIONS: Despite the possibility of re-infection, modest rates of hepatitis C treatment among active injecting drug users could effectively reduce transmission. Evaluating and extending strategies to treat hepatitis C among active injectors are warranted.<br/>

Item Type: Article
Faculty and Department: Faculty of Public Health and Policy > Dept of Global Health and Development
Faculty of Public Health and Policy > Dept of Social and Environmental Health Research
Research Centre: Social and Mathematical Epidemiology (SaME)
SaME Modelling & Economics
PubMed ID: 21145810
Web of Science ID: 291523000010
URI: http://researchonline.lshtm.ac.uk/id/eprint/1885

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