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

Natasha K Martin, Peter Vickerman, Graham R Foster, Sharon J Hutchinson, David J Goldberg, Matthew Hickman

Research output: Contribution to journalArticle (Academic Journal)peer-review

177 Citations (Scopus)

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.

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.

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%.

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.

Translated title of the contributionCan antiviral therapy for hepatitis C reduce the prevalence of HCV among injecting drug user populations? A modeling analysis of its prevention utility
Original languageEnglish
Pages (from-to)1137-1144
Number of pages8
JournalJournal of Hepatology
Volume54
Issue number6
DOIs
Publication statusPublished - Jun 2011

Bibliographical note

Copyright © 2010 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

Keywords

  • Antiviral Agents
  • Hepatitis C
  • Humans
  • Models, Biological
  • Prevalence
  • Substance Abuse, Intravenous
  • Time Factors

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