BACKGROUND & AIMS Prevention of hepatitis C virus (HCV) transmission among people who inject drugs (PWID) is critical for eliminating HCV in Europe. We estimated the impact of current and scaled-up HCV treatment with and without scaling up opioid substitution therapy (OST) and needle and syringe programmes (NSPs) across Europe over the next 10 years. METHODS We collected data on PWID HCV treatment rates, PWID prevalence, HCV prevalence, OST, and NSP coverage from 11 European settings. We parameterised an HCV transmission model to setting-specific data that project chronic HCV prevalence and incidence among PWID. RESULTS At baseline, chronic HCV prevalence varied from <25% (Slovenia/Czech Republic) to >55% (Finland/Sweden), and <2% (Amsterdam/Hamburg/Norway/Denmark/Sweden) to 5% (Slovenia/Czech Republic) of chronically infected PWID were treated annually. The current treatment rates using new direct-acting antivirals (DAAs) may achieve observable reductions in chronic prevalence (38-63%) in 10 years in Czech Republic, Slovenia, and Amsterdam. Doubling the HCV treatment rates will reduce prevalence in other sites (12-24%; Belgium/Denmark/Hamburg/Norway/Scotland), but is unlikely to reduce prevalence in Sweden and Finland. Scaling-up OST and NSP to 80% coverage with current treatment rates using DAAs could achieve observable reductions in HCV prevalence (18-79%) in all sites. Using DAAs, Slovenia and Amsterdam are projected to reduce incidence to 2 per 100 person years or less in 10 years. Moderate to substantial increases in the current treatment rates are required to achieve the same impact elsewhere, from 1.4 to 3 times (Czech Republic and France), 5-17 times (France, Scotland, Hamburg, Norway, Denmark, Belgium, and Sweden), to 200 times (Finland). Scaling-up OST and NSP coverage to 80% in all sites reduces treatment scale-up needed by 20-80%. CONCLUSIONS The scale-up of HCV treatment and other interventions is needed in most settings to minimise HCV transmission among PWID in Europe. LAY SUMMARY Measuring the amount of HCV in the population of PWID is uncertain. To reduce HCV infection to minimal levels in Europe will require scale-up of both HCV treatment and other interventions that reduce injecting risk (especially OST and provision of sterile injecting equipment).

中文翻译：

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HCV 治疗对预防欧洲注射吸毒者 HCV 传播影响的模型预测


背景与目标 预防丙型肝炎病毒 (HCV) 在注射吸毒者 (PWID) 中传播对于消除欧洲的丙型肝炎病毒至关重要。我们估计了未来 10 年欧洲当前和扩大的 HCV 治疗（无论是否扩大阿片类药物替代疗法 (OST) 和针头和注射器计划 (NSP)）的影响。方法 我们收集了来自 11 个欧洲国家的注射吸毒者 HCV 治疗率、注射吸毒者 HCV 患病率、HCV 患病率、OST 和 NSP 覆盖率的数据。我们将 HCV 传播模型参数化为特定环境数据，预测吸毒者中慢性 HCV 患病率和发病率。结果 基线时，慢性 HCV 感染率从 <25 id=91>55%（芬兰/瑞典）、<2%（阿姆斯特丹/汉堡/挪威/丹麦/瑞典）到 5%（斯洛文尼亚/捷克共和国）不等。每年都会对吸毒者进行治疗。目前使用新型直接抗病毒药物 (DAA) 的治疗率可能会在 10 年内显着降低捷克共和国、斯洛文尼亚和阿姆斯特丹的慢性患病率 (38-63%)。将 HCV 治疗率加倍将降低其他地区的患病率（12-24%；比利时/丹麦/汉堡/挪威/苏格兰），但不太可能降低瑞典和芬兰的患病率。在目前使用 DAA 的治疗率下，将 OST 和 NSP 覆盖率扩大到 80%，可以显着降低所有地点的 HCV 患病率 (18-79%)。通过使用 DAA，斯洛文尼亚和阿姆斯特丹预计将在 10 年内将发病率降低至每 100 人年 2 例或更少。其他地方需要适度到大幅度提高当前的治疗率才能达到同样的效果，从 1.4 倍到 3 倍（捷克共和国和法国）、5 到 17 倍（法国、苏格兰、汉堡、挪威、丹麦、比利时和瑞典） , 至 200 倍（芬兰）。 将所有地点的 OST 和 NSP 覆盖率扩大至 80%，可将所需的治疗规模扩大 20-80%。结论 在大多数情况下，需要扩大 HCV 治疗和其他干预措施，以尽量减少欧洲吸毒者中 HCV 的传播。简单总结 测量吸毒者人群中丙型肝炎病毒的数量是不确定的。为了将欧洲的丙肝病毒感染降低到最低水平，需要扩大丙肝病毒治疗和其他降低注射风险的干预措施（特别是 OST 和提供无菌注射设备）。