High Efficiency and Safety of Hepatitis C Treatment Among People Who Inject Drugs in Vietnam

IF 2.3 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY
Didier Laureillard, Nguyen Thanh Binh, Vu Hai Vinh, Tran Thi Hong, Catherine Quillet, Nham Thi Tuyet Thanh, Roselyne Vallo, Bach Thi Nhu Quynh, Jean Pierre Moles, Khuat Thi Hai Oanh, Duong Thi Huong, Delphine Rapoud, Jonathan Feelemyer, Laurent Michel, Peter Vickerman, Hannah Fraser, Laurence Weiss, Maud Lemoine, Karine Lacombe, Don Des Jarlais, Pham Minh Khue, Nicolas Nagot
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Abstract

People who inject drugs (PWID) are highly affected by hepatitis C (HCV) worldwide, particularly in low- and middle-income countries (LMICs), where access to addiction services is often limited. Reducing the burden of HCV, as promoted by WHO, requires effective interventions in this high-risk population. Here, we report the safety and efficacy of a pangenotypic generic HCV treatment among PWID in Vietnam, using a sofosbuvir/daclatasvir regimen. PWID were screened for HCV at two community-based organisations (CBO) premises in Haiphong during both a respondent-driven sampling survey and cohort follow-up visits. PWID with detectable HCV RNA were referred to three public hospitals for a 12-week regimen of generic sofosbuvir/daclatasvir, with ribavirin if cirrhosis, and with CBO support for referral and adherence. Treatment safety was assessed over the course of treatment and success was measured by sustained virologic response 12 weeks after the end of treatment (SVR12). Of the 1201 PWID screened with detectable HCV RNA, 1021 were enrolled: 96% male, median age 42 years, 45% HIV-infected, 16% with advanced liver fibrosis, 55% currently injecting, and 71.5% on methadone maintenance therapy (MMT). In total, 979 participants started HCV treatment, and 901 of the 924 participants tested at SVR12 (98%) were cured. Genotype 3, current drug use, lack of MMT, and HIV infection were independently associated with treatment failure. High HCV cure rates can be achieved among PWID in LMICs such as Vietnam using a simple model of care, including a pangenotypic generic direct-acting antiviral combination and CBO support.

Trial Registration: ClinicalTrials.gov identifier: NCT03537196

Abstract Image

越南注射吸毒者丙型肝炎治疗的高效率和安全性。
全世界注射吸毒者受到丙型肝炎(HCV)的严重影响,特别是在低收入和中等收入国家(LMICs),这些国家获得戒毒服务的机会往往有限。如世卫组织所推动的那样,减轻丙型肝炎病毒负担需要对这一高危人群进行有效干预。在这里,我们报告了在越南使用索非布韦/daclatasvir方案治疗PWID的泛型通用HCV的安全性和有效性。在海防的两个社区组织(CBO)场所,通过受访者驱动的抽样调查和队列随访,对PWID进行了HCV筛查。可检测到HCV RNA的PWID被转诊到三家公立医院,接受为期12周的索非布韦/daclatasvir通用方案,肝硬化患者使用利巴韦林,CBO支持转诊和依从性。在整个治疗过程中评估治疗安全性,并通过治疗结束后12周的持续病毒学反应(SVR12)来衡量成功。在通过检测HCV RNA筛选的1201例PWID中,1021例入组:96%为男性,中位年龄42岁,45%为hiv感染,16%为晚期肝纤维化,55%目前正在注射,71.5%正在接受美沙酮维持治疗(MMT)。总共有979名参与者开始了HCV治疗,在SVR12测试的924名参与者中有901名(98%)治愈。基因3型、目前的药物使用、缺乏MMT和HIV感染与治疗失败独立相关。在越南等中低收入国家的PWID中,使用一种简单的护理模式,包括泛型通用直接作用抗病毒药物组合和CBO支持,可以实现HCV的高治愈率。试验注册:ClinicalTrials.gov标识符:NCT03537196。
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来源期刊
Journal of Viral Hepatitis
Journal of Viral Hepatitis 医学-病毒学
CiteScore
6.00
自引率
8.00%
发文量
138
审稿时长
1.5 months
期刊介绍: The Journal of Viral Hepatitis publishes reviews, original work (full papers) and short, rapid communications in the area of viral hepatitis. It solicits these articles from epidemiologists, clinicians, pathologists, virologists and specialists in transfusion medicine working in the field, thereby bringing together in a single journal the important issues in this expanding speciality. The Journal of Viral Hepatitis is a monthly journal, publishing reviews, original work (full papers) and short rapid communications in the area of viral hepatitis. It brings together in a single journal important issues in this rapidly expanding speciality including articles from: virologists; epidemiologists; clinicians; pathologists; specialists in transfusion medicine.
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