title: The effect of hepatitis C treatment and human immunodeficiency virus (HIV) co-infection on the disease burden of hepatitis C among injecting drug users in Amsterdam.
abstract: OBJECTIVE
  The hepatitis C virus (HCV) disease burden among injecting drug users (IDUs) is determined by HCV incidence, the long latency period of HCV, competing mortality causes, presence of co-infection and HCV treatment uptake. We examined the effect of these factors and estimated the HCV disease burden in Amsterdam.
  
  
  METHODS
  A Markov model was developed, incorporating HCV and human immunodeficiency virus (HIV), and parameterized with data from the Amsterdam Cohort Studies, surveillance studies and literature.
  
  
  METHODS
  IDU population of Amsterdam.
  
  
  METHODS
  HCV infection simulated from its acute phase to HCV-related liver disease (i.e. decompensated cirrhosis and hepatocellular carcinoma).
  
  
  RESULTS
  The HCV prevalence among IDUs in Amsterdam increased to approximately 80% in the 1980s. From 2011 to 2025, the HCV-related disease prevalence will accordingly rise by 36%, from 57 cases (95% range 33-94) to 78 (95% range 43-138), respectively. In total, 945 (95% range 617-1309) individuals will develop HCV-related liver disease. This burden would have been 33% higher in the absence of HIV, resulting in 1219 cases (95% range 796-1663). In Amsterdam, 25% of HIV-negative IDUs receive successful HCV treatment, reducing the cumulative disease burden by 14% to 810 (95% range 520-1120). Further reduction of 36% can be achieved by improving treatment, resulting in 603 cases (95% range 384-851).
  
  
  CONCLUSIONS
  The hepatitis C virus burden among injecting drug users in Amsterdam has been reduced by a high competing mortality rate, particularly caused by HIV infection, and to a smaller extent by hepatitis C virus treatment. Improved hepatitis C virus treatment is expected to contribute to reduce the future hepatitis C virus disease burden.
authors.affiliation: Cluster of infectious diseases, Amsterdam Public Health Service, Amsterdam, The Netherlands. amatser@ggd.amsterdam.nl
authors.forename: Amy
authors.initials: A
authors.lastname: Matser
authors.forename: Anouk
authors.initials: A
authors.lastname: Urbanus
authors.forename: Ronald
authors.initials: R
authors.lastname: Geskus
authors.forename: Mirjam
authors.initials: M
authors.lastname: Kretzschmar
authors.forename: Maria
authors.initials: M
authors.lastname: Xiridou
authors.forename: Marcel
authors.initials: M
authors.lastname: Buster
authors.forename: Roel
authors.initials: R
authors.lastname: Coutinho
authors.forename: Maria
authors.initials: M
authors.lastname: Prins
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D060085:Coinfection / Q000150:complications* / Q000401:mortality; D017281:Cost of Illness; D015658:HIV Infections / Q000150:complications* / Q000401:mortality / Q000628:therapy; D006526:Hepatitis C / Q000150:complications / Q000401:mortality / Q000628:therapy*; D006801:Humans; D015994:Incidence; D008390:Markov Chains; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence; D015819:Substance Abuse, Intravenous / Q000150:complications* / Q000401:mortality; D055815:Young Adult