Hepatitis C Virus treatment as prevention in people who inject drugs: testing the evidence: testing the evidence

Mathew Hickman, Daniela De Angelis, Peter Vickerman, Sharon Hutchinson, Natasha Martin

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Abstract

Purpose of Review—The majority of HCV infections in UK and many developing countries were acquired through injecting. New clinical guidance suggests that HCV treatment should be offered to people with a transmission risk – such as people who inject drugs (PWID) – irrespective of severity of liver disease. We consider the strength of the evidence base and potential problems in evaluating HCV treatment as prevention among PWID.
Recent Findings—There is good theoretical evidence from dynamic models that HCV treatment for PWID could reduce HCV chronic prevalence and incidence among PWID. Economic evaluations from high-income settings have suggested HCV treatment for PWID is cost-effective, and that in many settings HCV treatment of PWID could be more cost-effective than treating those at an equivalent stage with no ongoing transmission risk. Epidemiological studies of older interferon treatments have suggested that PWID can achieve similar treatment outcomes to other patient groups treated for chronic HCV. Impact and cost-effectiveness of HCV treatment is driven by the potential “prevention benefit” of treating PWID. Model projections suggest that more future infections, End Stage Liver Disease, and HCV related deaths will be averted than lost through re-infection of PWID treated successfully for HCV. However, there is to date no empirical evidence from trials or observational studies that test the model projections and “prevention benefit” hypothesis. In part this also is because of uncertainty in the evidence base but also because PWID HCV treatment rates historically in most sites have been low, and any scale-up and switch to the new DAA has not yet occurred. There are a number of key uncertainties in the data available on PWID that need to be improved and addressed in order to evaluate treatment as prevention. These include estimates of the prevalence of PWID, measurements of HCV chronic prevalence and incidence among PWID, and how to interpret reinfection rates as potential outcome measures.
Summary—Eliminating HCV through scaling up treatment is a theoretical possibility. But empirical data are required to demonstrate that HCV treatment can reduce HCV transmission which will require an improved evidence base and analytic framework for measuring PWID and HCV prevalence.
Original languageEnglish
Pages (from-to)576-582
Number of pages7
JournalCurrent Opinion in Infectious Diseases
Volume28
Issue number6
DOIs
Publication statusPublished - 1 Dec 2015

Keywords

  • HCV
  • injecting drugs use
  • treatment
  • prevention
  • evaluation

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