Clinical Edge

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HCV Treatment as Prevention in PWIDs

Lancet; 2018 Feb; Zelenev, Li, et al

Among people who inject drugs (PWID) in the US, successful hepatitis C virus (HCV) treatment as prevention should incorporate the baseline HCV and will achieve the greatest benefit when coverage is expanded, a recent study found. Five graph models were fit using data from 1,574 PWID in Hartford, CT. Researchers simulated transmission of HCV and HIV through this network with varying levels of HCV treatment coverage and varying baseline HCV prevalence in PWID. They then compared the effectiveness of 7 treatment-as-prevention strategies on reducing HCV prevalence over 10 years and 20 years vs no treatment. They found:

  • At the highest baseline HCV prevalence in PWID (85%), expansion of treatment does not substantially reduce HCV prevalence for any treatment-as-prevention strategy.
  • However, when baseline HCV prevalence is ≤60%, treating >120 (12%) individuals per 1,000 PWID per year would likely eliminate HCV within 10 years.
  • On average, assigning treatment randomly to individuals who inject drugs is better than targeting individuals with the most injection partners.

Citation:

Zelenev A, Li J, Mazhnaya A, Basu S, Altice FL. Hepatitis C virus treatment as prevention in an extended network of people who inject drugs in the USA: A modelling study. Lancet. 2018;18(2):215-224. doi:10.1016/S1473-3099(17)30676-X.

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