Skip to main navigation menu Skip to main content Skip to site footer

Original article

Vol. 147 No. 4546 (2017)

Hepatitis C virus dynamics among intravenous drug users suggest that an annual treatment uptake above 10% would eliminate the disease by 2030

  • Philip Bruggmann
  • Sarah Blach
  • Pierre Deltenre
  • Jan Fehr
  • Roger D. Kouyos
  • Daniel Lavanchy
  • Beat Müllhaupt
  • Andri Rauch
  • Homie Razavi
  • Patrick Schmid
  • David Semela
  • Marcel Stöckle
  • Franco Negro
DOI
https://doi.org/10.4414/smw.2017.14543
Cite this as:
Swiss Med Wkly. 2017;147:w14543
Published
08.11.2017

Summary

BACKGROUND AND AIMS

In Switzerland, the prevalence of hepatitis C virus (HCV) among people who inject drugs (PWID) has been decreasing owing to active harm reduction efforts and an aging population. Recent advances in HCV therapeutics may provide an opportunity to direct treatment to high-risk populations, with a goal of reducing HCV prevalence and preventing new infections. In order to guide these efforts, the current project was undertaken with the following aims: (1) to develop a simple model to estimate the number of new HCV infections using available data on PWID; (2) to examine the impact of intervention strategies (prevention and treatment) on new and total HCV infections among PWID.

METHODS

A dynamic HCV transmission model was used to track HCV incidence and prevalence among active PWID according to their harm reduction status. The relative impact of treating 1, 5, 10 or 15% of HCV+ PWID with new oral direct acting antivirals was considered.

RESULTS

In 2015, there were an estimated 10 160 active PWID in Switzerland, more than 85% of whom were engaged in harm reduction programmes. Approximately 42% of active PWID were HCV-RNA+, with 55 new viraemic infections occurring annually. By 2030, a 60% reduction in the HCV+ PWID population would be expected. In the absence of behavioural changes, the number of secondary infections would increase under all treatment scenarios. With high level treatment, the number of secondary infections would peak and then drop, corresponding to depletion of the viral pool. In Switzerland, 5% treatment of the 2015 HCV+ PWID population per year would result in a 95% reduction in total cases by 2030, whereas ≥10% treatment would result in a >99% reduction.

CONCLUSIONS

Timely treatment of hepatitis C virus among people who inject drugs is necessary to reduce the prevalence and prevent new infections in Switzerland.

References

  1. Müllhaupt B, Bruggmann P, Bihl F, Blach S, Lavanchy D, Razavi H, et al. Modeling the Health and Economic Burden of Hepatitis C Virus in Switzerland. PLoS One. 2015;10(6):e0125214. doi:.https://doi.org/10.1371/journal.pone.0125214
  2. Health SFOoP. Source of infection among mandatory notified cases of hepatitis C, Switzerland 1993-2011: FOPH/MT/EPI/RIC. 2012.
  3. Bruggmann P, Kormann A, Meili D. Heroin substitution: an exception or an expanded feasibility for providing hepatitis treatment to drug users? Hot Topics in Viral Hepatitis. 2009;5(13):27–33.
  4. Leask JD, Dillon JF. Review article: treatment as prevention - targeting people who inject drugs as a pathway towards hepatitis C eradication. Aliment Pharmacol Ther. 2016;44(2):145–56. doi:.https://doi.org/10.1111/apt.13673
  5. Nordt C, Stohler R. Combined effects of law enforcement and substitution treatment on heroin mortality. Drug Alcohol Rev. 2010;29(5):540–5. doi:.https://doi.org/10.1111/j.1465-3362.2009.00167.x
  6. Balthasar H, Huissoud T, Zobel F, Arnaud S, Samitca S, Jeannin A. [Evolution of the consumption and practices in risk of transmission of HIV and HCV in injection drug users in Switzerland, 1993-2006]. Bulletin of the Swiss Federal Office of Public Health. 2007;45:804–9.
  7. Lociciro S, Gervasoni JP, Jeannin A, Dubois-Arber F. [Survey of drug users, clients of low-threshold facilities (SBS) in Switzerland. 1993-2011 trends.]. Lausanne, Switzerland: University Institute for Social and Preventive Medicine; 2013.
  8. The National Methadone Statistics 1999-2014 [Internet]. 2015 [cited 1/20/2015]. Available from: http://www.bag.admin.ch/themen/drogen/00042/00632/06217/index.html?lang=de.
  9. Dickson-Spillmann M, Haug S, Uchtenhagen A, Bruggmann P, Schaub MP. Rates of HIV and Hepatitis Infections in Clients Entering Heroin-Assisted Treatment between 2003 and 2013 and Risk Factors for Hepatitis C Infection. Eur Addict Res. 2016;22(4):181–91. doi:.https://doi.org/10.1159/000441973
  10. Uchtenhagen A. Heroin-assisted treatment in Switzerland: a case study in policy change. Addiction. 2010;105(1):29–37. doi:.https://doi.org/10.1111/j.1360-0443.2009.02741.x
  11. Gschwend P, Rehm J, Lezzi S, Blättler R, Steffen T, Gutzwiller F, et al. Development of a monitoring system for heroin-assisted substitution treatment in Switzerland. Soz Praventivmed. 2002;47(1):33–8. doi:.https://doi.org/10.1007/BF01318403
  12. Razavi H, Elkhoury AC, Elbasha E, Estes C, Pasini K, Poynard T, et al. Chronic hepatitis C virus (HCV) disease burden and cost in the United States. Hepatology. 2013;57(6):2164–70. doi:.https://doi.org/10.1002/hep.26218
  13. Razavi H, Waked I, Sarrazin C, Myers RP, Idilman R, Calinas F, et al. The present and future disease burden of hepatitis C virus (HCV) infection with today’s treatment paradigm. J Viral Hepat. 2014;21(Suppl 1):34–59. doi:.https://doi.org/10.1111/jvh.12248
  14. Centers for Disease Control and Prevention (CDC). Recommendations for follow-up of health-care workers after occupational exposure to hepatitis C virus. MMWR Morb Mortal Wkly Rep. 1997;46(26):603–6.
  15. Mitsui T, Iwano K, Masuko K, Yamazaki C, Okamoto H, Tsuda F, et al. Hepatitis C virus infection in medical personnel after needlestick accident. Hepatology. 1992;16(5):1109–14. doi:.https://doi.org/10.1002/hep.1840160502
  16. Hasan F, Askar H, Al Khalidi J, Al Shamali M, Al Kalaoui M, Al Nakib B. Lack of transmission of hepatitis C virus following needlestick accidents. Hepatogastroenterology. 1999;46(27):1678–81.
  17. Tsui JI, Evans JL, Lum PJ, Hahn JA, Page K. Association of opioid agonist therapy with lower incidence of hepatitis C virus infection in young adult injection drug users. JAMA Intern Med. 2014;174(12):1974–81. doi:.https://doi.org/10.1001/jamainternmed.2014.5416
  18. Turner KM, Hutchinson S, Vickerman P, Hope V, Craine N, Palmateer N, et al. The impact of needle and syringe provision and opiate substitution therapy on the incidence of hepatitis C virus in injecting drug users: pooling of UK evidence. Addiction. 2011;106(11):1978–88. doi:.https://doi.org/10.1111/j.1360-0443.2011.03515.x
  19. Van Den Berg C, Smit C, Van Brussel G, Coutinho R, Prins M ; Amsterdam Cohort. Full participation in harm reduction programmes is associated with decreased risk for human immunodeficiency virus and hepatitis C virus: evidence from the Amsterdam Cohort Studies among drug users. Addiction. 2007;102(9):1454–62. doi:.https://doi.org/10.1111/j.1360-0443.2007.01912.x
  20. White B, Dore GJ, Lloyd AR, Rawlinson WD, Maher L. Opioid substitution therapy protects against hepatitis C virus acquisition in people who inject drugs: the HITS-c study. Med J Aust. 2014;201(6):326–9. doi:.https://doi.org/10.5694/mja13.00153
  21. Hagan H, Pouget ER, Des Jarlais DC. A systematic review and meta-analysis of interventions to prevent hepatitis C virus infection in people who inject drugs. J Infect Dis. 2011;204(1):74–83. doi:.https://doi.org/10.1093/infdis/jir196
  22. MacArthur GJ, van Velzen E, Palmateer N, Kimber J, Pharris A, Hope V, et al. Interventions to prevent HIV and Hepatitis C in people who inject drugs: a review of reviews to assess evidence of effectiveness. Int J Drug Policy. 2014;25(1):34–52. doi:.https://doi.org/10.1016/j.drugpo.2013.07.001
  23. Arnaud S, Jeannin A, Dubois-Arber F. Estimating national-level syringe availability to injecting drug users and injection coverage: Switzerland, 1996-2006. Int J Drug Policy. 2011;22(3):226–32. doi:.https://doi.org/10.1016/j.drugpo.2011.03.008
  24. Cominetti F, Simonson T, Dubois-Arber F, IUMSP Gervasoni JP, ISGF Schaub M, SSP Monnat M. [Analysis of the HCV situation in drug users in Switzerland]. Lausanne, Switzerland; /2015. Report No.: Raisons de sante 2334a.
  25. Dubois-Arber F, Balthasar H, Huissoud T, Zobel F, Arnaud S, Samitca S, et al. Trends in drug consumption and risk of transmission of HIV and hepatitis C virus among injecting drug users in Switzerland, 1993-2006. Euro Surveill. 2008;13(21):18881. doi:.https://doi.org/10.2807/ese.13.21.18881-en
  26. Micallef JM, Kaldor JM, Dore GJ. Spontaneous viral clearance following acute hepatitis C infection: a systematic review of longitudinal studies. J Viral Hepat. 2006;13(1):34–41. doi:.https://doi.org/10.1111/j.1365-2893.2005.00651.x
  27. Bruggmann P. OST and injecting, ARUD centers, 2010-2013. In: Blach S, editor. 2015.
  28. Nordt C. OST and injecting in Zurich. In: Blach S, editor. 2015.
  29. Huissoud T, Rousson V, Dubois-Arber F. Methadone treatments in a Swiss region, 2001-2008: a registry-based analysis. BMC Psychiatry. 2012;12(1):238. doi:.https://doi.org/10.1186/1471-244X-12-238
  30. Health FOoP. Affairs FDoH, Program DoNP. [Treatment with prescription heroin/diacetylmorphine (HeGeBe), in 2009 and 2010]. Laussane; 2011.
  31. Dickson-Spillman M, Hiltebrand D, Bollinger H, Schaub M. Heroin-assisted treatment in Switzerland: Results of the survey in 2013. Zurich; 2014.

Most read articles by the same author(s)

1 2 3 4 > >>