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

J Hepatol. 2010 Dec 8. [Epub ahead of print]

Martin NK, Vickerman P, Foster GR, Hutchinson SJ, Goldberg DJ, Hickman M.

Department of Social Medicine, University of Bristol, Bristol, UK; Health Policy Unit, London School of Hygiene and Tropical Medicine, London, UK.

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 amongst 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 then current evidence suggests; retreatment of treatment failures does not alter the short-term (<5 year) 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 amongst active injecting drug users could effectively reduce transmission. Evaluating and extending strategies to treat hepatitis C among active injectors is warranted.

Copyright © 2010. Published by Elsevier B.V.

PMID: 21145810 [PubMed - as supplied by publisher]

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