<scp>HCV</scp> treatment rates and sustained viral response among people who inject drugs in seven <scp>UK</scp> sites: real world results and modelling of treatment impact

Abstract

<jats:title>Summary</jats:title><jats:p>Hepatitis C virus (<jats:styled-content style="fixed-case">HCV</jats:styled-content>) antiviral treatment for people who inject drugs (<jats:styled-content style="fixed-case">PWID</jats:styled-content>) could prevent onwards transmission and reduce chronic prevalence. We assessed current <jats:styled-content style="fixed-case">PWID</jats:styled-content> treatment rates in seven <jats:styled-content style="fixed-case">UK</jats:styled-content> settings and projected the potential impact of current and scaled‐up treatment on <jats:styled-content style="fixed-case">HCV</jats:styled-content> chronic prevalence. Data on number of <jats:styled-content style="fixed-case">PWID</jats:styled-content> treated and sustained viral response rates (<jats:styled-content style="fixed-case">SVR</jats:styled-content>) were collected from seven <jats:styled-content style="fixed-case">UK</jats:styled-content> settings: Bristol (37–48% <jats:styled-content style="fixed-case">HCV</jats:styled-content> chronic prevalence among <jats:styled-content style="fixed-case">PWID</jats:styled-content>), East London (37–48%), Manchester (48–56%), Nottingham (37–44%), Plymouth (30–37%), Dundee (20–27%) and North Wales (27–33%). A model of <jats:styled-content style="fixed-case">HCV</jats:styled-content> transmission among <jats:styled-content style="fixed-case">PWID</jats:styled-content> projected the 10‐year impact of (i) current treatment rates and <jats:styled-content style="fixed-case">SVR</jats:styled-content> (ii) scale‐up with interferon‐free direct acting antivirals (<jats:styled-content style="fixed-case">IFN</jats:styled-content>‐free <jats:styled-content style="fixed-case">DAA</jats:styled-content>s) with 90% <jats:styled-content style="fixed-case">SVR</jats:styled-content>. Treatment rates varied from &lt;5 to over 25 per 1000 <jats:styled-content style="fixed-case">PWID</jats:styled-content>. Pooled intention‐to‐treat <jats:styled-content style="fixed-case">SVR</jats:styled-content> for <jats:styled-content style="fixed-case">PWID</jats:styled-content> were 45% genotypes 1/4 [95%<jats:styled-content style="fixed-case">CI</jats:styled-content> 33–57%] and 61% genotypes 2/3 [95%<jats:styled-content style="fixed-case">CI</jats:styled-content> 47–76%]. Projections of chronic <jats:styled-content style="fixed-case">HCV</jats:styled-content> prevalence among <jats:styled-content style="fixed-case">PWID</jats:styled-content> after 10 years of current levels of treatment overlapped substantially with current <jats:styled-content style="fixed-case">HCV</jats:styled-content> prevalence estimates. Scaling‐up treatment to 26/1000 <jats:styled-content style="fixed-case">PWID</jats:styled-content> annually (achieved already in two sites) with <jats:styled-content style="fixed-case">IFN</jats:styled-content>‐free <jats:styled-content style="fixed-case">DAA</jats:styled-content>s could achieve an observable absolute reduction in <jats:styled-content style="fixed-case">HCV</jats:styled-content> chronic prevalence of at least 15% among <jats:styled-content style="fixed-case">PWID</jats:styled-content> in all sites and greater than a halving in chronic <jats:styled-content style="fixed-case">HCV</jats:styled-content> in Plymouth, Dundee and North Wales within a decade. Current treatment rates among <jats:styled-content style="fixed-case">PWID</jats:styled-content> are unlikely to achieve observable reductions in <jats:styled-content style="fixed-case">HCV</jats:styled-content> chronic prevalence over the next 10 years. Achievable scale‐up, however, could lead to substantial reductions in <jats:styled-content style="fixed-case">HCV</jats:styled-content> chronic prevalence.</jats:p>