title: Hepatitis C treatment as prevention of viral transmission and liver-related morbidity in persons who inject drugs.
abstract: Hepatitis C virus (HCV) seroprevalence remains high in people who inject drug (PWID) populations, often above 60%. Highly effective direct-acting antiviral (DAA) regimens (90% efficacy) are becoming available for HCV treatment. This therapeutic revolution raises the possibility of eliminating HCV from this population. However, for this, an effective cascade of care is required. In the context of the available DAA therapies, we used a dynamic individual-based model including a model of the PWID social network to simulate the impact of improved testing, linkage to care, and adherence to treatment, and of modified treatment recommendation on the transmission and on the morbidity of HCV in PWID in France. Under the current incidence and cascade of care, with treatment initiated at fibrosis stage ≥F2, HCV prevalence decreased from 42.8% to 24.9% (95% confidence interval: 24.8-24.9) after 10 years. Changing treatment initiation criteria to treat from F0 was the only intervention leading to a substantial additional decrease in prevalence, which fell to 11.6% (95% CI: 11.6-11.7) at 10 years. Combining this change with improved testing, linkage to care, and adherence to treatment decreased HCV prevalence to 7.0% (95% CI: 7.0-7.1) at 10 years and avoided 15% (95% CI: 14-17) and 29% (95% CI: 28-30) of cirrhosis complications over 10 and 40 years, respectively.
  
  
  CONCLUSIONS
  Major decreases in prevalent HCV infections occur only when treatment is initiated at early stages of fibrosis, suggesting that systematic treatment in PWID, where incidence remains high, would be beneficial. However, elimination within the 10 next years will be difficult to achieve using treatment alone, even with a highly improved cascade of care.
authors.affiliation: IAME, UMR 1137, INSERM, F-75018, Paris, France.|IAME, UMR 1137, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.
authors.forename: Anthony
authors.initials: A
authors.lastname: Cousien
authors.affiliation: Laboratoire Paul Painlevé UMR CNRS 8524, UFR de Mathématiques, Université des Sciences et Technologies Lille 1, Cité Scientifique, Villeneuve d'Ascq, France.
authors.forename: Viet Chi
authors.initials: VC
authors.lastname: Tran
authors.affiliation: IAME, UMR 1137, INSERM, F-75018, Paris, France.|IAME, UMR 1137, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.|Inserm, LIRIC-UMR995, Lille, France, Université Lille, Lille, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Deuffic-Burban
authors.affiliation: CERMES3: Centre de Recherche Médecine, Sciences, Santé, Santé Mentale et Société, (INSERM U988/UMR CNRS8211/Université Paris Descartes, Ecole des Hautes Etudes en Sciences Sociales), Paris, France.|Institut de Veille Sanitaire, Saint-Maurice, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Jauffret-Roustide
authors.affiliation: Université Paris 13, Sorbonne Paris Cité, LAGA, CNRS, UMR 7539, Villetaneuse, France.
authors.forename: Jean-Stéphane
authors.initials: JS
authors.lastname: Dhersin
authors.affiliation: IAME, UMR 1137, INSERM, F-75018, Paris, France.|IAME, UMR 1137, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.|Service des Maladies Infectieuses et Tropicales, Hôpital Bichat Claude Bernard, Paris, France.
authors.forename: Yazdan
authors.initials: Y
authors.lastname: Yazdanpanah
mesh_terms: D000367:Age Factors; D000998:Antiviral Agents / Q000008:administration & dosage; D015897:Comorbidity; D018450:Disease Progression; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D005260:Female; D006526:Hepatitis C / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology* / Q000635:transmission; D006801:Humans; D008103:Liver Cirrhosis / Q000453:epidemiology* / Q000517:prevention & control / Q000821:virology; D008297:Male; D008962:Models, Theoretical; D011322:Primary Prevention / Q000379:methods; D011379:Prognosis; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016036:Seroepidemiologic Studies; D012737:Sex Factors; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000453:epidemiology*; D016019:Survival Analysis
chemical_list: D000998:Antiviral Agents