HCVtreatment rates and sustained viral response among people who inject drugs in sevenUKsites: real world results and modelling of treatment impact

Abstract

Hepatitis C virus (HCV) antiviral treatment for people who inject drugs (PWID) could prevent onwards transmission and reduce chronic prevalence. We assessed current PWID treatment rates in seven UK settings and projected the potential impact of current and scaled-up treatment on HCV chronic prevalence. Data on number of PWID treated and sustained viral response rates (SVR) were collected from seven UK settings: Bristol (37–48% HCV chronic prevalence among PWID), East London (37–48%), Manchester (48–56%), Nottingham (37–44%), Plymouth (30–37%), Dundee (20–27%) and North Wales (27–33%). A model of HCV transmission among PWID projected the 10-year impact of (i) current treatment rates and SVR (ii) scale-up with interferon-free direct acting antivirals (IFN-free DAAs) with 90% SVR. Treatment rates varied from <5 to over 25 per 1000 PWID. Pooled intention-to-treat SVR for PWID were 45% genotypes 1/4 [95%CI 33–57%] and 61% genotypes 2/3 [95%CI 47–76%]. Projections of chronic HCV prevalence among PWID after 10 years of current levels of treatment overlapped substantially with current HCV prevalence estimates. Scaling-up treatment to 26/1000 PWID annually (achieved already in two sites) with IFN-free DAAs could achieve an observable absolute reduction in HCV chronic prevalence of at least 15% among PWID in all sites and greater than a halving in chronic HCV in Plymouth, Dundee and North Wales within a decade. Current treatment rates among PWID are unlikely to achieve observable reductions in HCV chronic prevalence over the next 10 years. Achievable scale-up, however, could lead to substantial reductions in HCV chronic prevalence.

Assessing the impact and cost-effectiveness of needle and syringe provision and opioid substitution therapy on hepatitis C transmission among people who inject drugs in the UK: an analysis of pooled data sets and economic modelling

“…Despite coverage being high in many settings, the projections also suggest that important benefits could still be achieved from scaling up NSP further, especially in settings with current low coverage levels. In addition, as suggested by other recent modelling analyses, 99,114 scaling up other interventions such as HCV infection treatment could also have a large impact on HCV transmission, although treatment will need to scale up considerably to see a large impact on incident infections. Importantly, strategies need to be devised to tackle or reduce the harms associated with homelessness and crack cocaine injection among PWID, which our modelling suggests is doubling the level of transmission in each setting.…”

“…Before 2015, we estimated the SVR rate for pegylated interferon and ribavirin from a recent study of PWID in the UK. 99 After 2015, we assumed that treatment would involve using the new direct-acting antiviral (DAA) drugs, and so assumed a high SVR rate of 90% for all genotypes. 103 Instantaneous HCV infection disease stage progression rates were calculated from a recent meta-analysis of PWID-specific progression probabilities to compensated cirrhosis 101 and a systematic review of general progression probabilities for other disease stages, 101 and, similarly, the spontaneous clearance probability came from a published meta-analysis.…”

HCV Cure and Reinfection Among People With HIV/HCV Coinfection and People Who Inject Drugs

“…Mathematical modelling suggests that substantial reductions in HCV incidence and prevalence could be achieved by targeted DAA treatment scale-up among those at the highest risk of ongoing transmission [6,16,77,78]. Using HCV treatment uptake data from seven sites in the UK, Martin et al demonstrated that treating 26 per 1000 HCV-infected PWID per annum with DAA therapy could achieve a 15-50% decrease in chronic HCV prevalence within 10 years [78].…”

“…Mathematical modelling suggests that substantial reductions in HCV incidence and prevalence could be achieved by targeted DAA treatment scale-up among those at the highest risk of ongoing transmission [6,16,77,78]. Using HCV treatment uptake data from seven sites in the UK, Martin et al demonstrated that treating 26 per 1000 HCV-infected PWID per annum with DAA therapy could achieve a 15-50% decrease in chronic HCV prevalence within 10 years [78]. Despite the high cost of DAA therapy, treating recent PWID and HIV-positive MSM with early liver disease appears to be cost-effective compared to delaying until cirrhosis, given the reduction in liver-related complications and additional benefit of averting secondary infections [7,8,79].…”

Hepatitis C and sex

“…This increase in chemsex led to the London Boroughs of Lambeth, Southwark and Lewisham commissioning the Chemsex Study. 23 It demonstrated that onequarter (all of whom were HIV positive) of those taking part in chemsex planned to engage in UPAI and one-third found it difficult to prevent engagement in STI transmission risk behaviour, which they subsequently regretted. Use of chemsex drugs was shown to be much more prevalent in these boroughs than the rest of London and more prevalent in London than the rest of the UK.…”