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PLOS Med: How should “addicts” be treated with hepatitis C?

Hepatitis C (hepatitis C) is a liver disease caused by hepatitis C virus (HCV). The virus can cause acute or chronic hepatitis infections, and its severity ranges from mild diseases that last for several weeks to severe diseases. Hepatitis C is a major pathogenic factor in liver cancer.

HCV is a blood transmission virus. The most common infection pathway is to contact a small amount of blood. Injecting drugs, unsafe injection methods, unsafe health care, input uns screening blood and blood products, and sexual behavior that can cause blood contact can cause infection.

Hepatitis C is seen around the world. The most affected areas are the Mediterranean and European regions. It is estimated that the popularity rates in 2015 are 2.3%and 1.5%, respectively. According to statistics, 23%of new hepatitis C infections and 33%of hepatitis C death can be attributed to injection drugs. However, injection of drug users and prisoners are often not included in the state response plan.

In recent years, the efficient and direct anti -virus (DAA) therapy for HCV infection has been launched, which has prompted WHO to formulate a global health strategy to eliminate HCV infection with this public health threat by 2030. To achieve this goal, the treatment model must be targeted at those who are currently injected or have injected with drugs (PWID).

Before 2014, HCV treatment was based on interferon. It not only had a general effect, but also had considerable adverse reactions. Therefore, the treatment acceptance rate was very low, especially in PWID. At present, the emergence of oral DAA has changed the HCV care mode and brought huge treatment prospects.

However, PWID’s HCV treatment coverage is far from popular. For these nursing models for PWID, better evidence. PWID is not easy to obtain standard testing and treatment of HCV infection in the tertiary medical institution. Eileen evaluated the effect of comprehensive treatment of chronic HCV infections in PWID. Statistical experts from the University of Polgen, Norwegian University, conducted an INTRO-HCV research, and the results were published in the latest PLOS Medicine magazine.

Intro-HCV is a multi-center, random control clinical trial. From 2017 to 2019, the participants recruited from the Norwegian drug agonist therapy (OAT) and community nursing clinics were randomly assigned to 2 treatment methods. Comprehensive therapy is provided by multidisciplinary teams of opioid stimulants or community nursing centers (CCCS) for drug -obstacles. Including on -site testing, liver fibrosis assessment, consulting, treatment and treatment follow -up.

Standard therapy was performed in the hospital clinic, and two groups of patients performed antiviral drugs (DAA) that directly used to act orally. The main result is the time and the continuous virus response (SVR) of the starting treatment. It is defined as the HCV RNA for 12 weeks after the treatment.

The Kaplan-Meier diagram indicates the time when HCV treatment starts. Red line/area indicates a comprehensive treatment group, blue dotted line/area represents standard treatment group

Of the 298 participants included, 150 were randomly assigned to standard treatment, of which 116/150 (77%) began treatment, 108/150 (72%) began treatment within one year after referral. Among the 148 people who were randomly received for comprehensive treatment, 145/148 (98%) began treatment, and 141/148 (95%) began treatment within one year after referral.

Compared with standard treatment, the comprehensive treatment group started treatment earlier, HR is 2.2 (1.7-2.9). In comprehensive treatment, 123 people (85%first treatment/83%owner) confirmed SVR, and in standard treatment, 96 (83%first treatment/64%owner) confirmed SVR. Therefore, comprehensive therapy can increase the first treatment and all patients by 50%and 180%of the benefits of 50%and 180%, respectively.

It can be seen that at the beginning of treatment, PWID’s HCV comprehensive treatment is better than standard treatment, and then more people have reached SVR. Among those who begin to treat, the SVR rate is equivalent. The scale of expanding the comprehensive treatment model may be an important tool for eliminating the HCV of drug users.


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