目的:直接抗病毒(DAA)治疗对丙型肝炎感染患者的肝脏结局具有积极作用;然而,关于其对注射药物(PWID)人群中药物相关住院和死亡率(DRM)的"肝外"结局的影响的证据不足.我们通过使用受试者内设计将治疗后与基线期进行比较来调查这些结果与DAA治疗之间的关联,以减少队列或病例对照设计的选择偏倚问题。
方法:这是一项自我对照的病例系列研究。
方法:苏格兰,2015年1月1日至2020年11月30日。
方法:非肝硬化的研究人群,DAA治疗的PWID是使用连接苏格兰丙型肝炎诊断的数据集确定的,HCV临床数据库,国家住院/日间病例医院记录和国家死亡登记册。三个主要结果(药物过量入院,使用ICD代码定义非病毒注射相关的入院和药物相关的死亡率)。
方法:使用自我对照病例系列方法来估计与治疗时间和此后六个90天暴露危险期相关的每个结局的相对发生率(RI)。
结果:在采样时间范围内,总共6050个PWID接受了DAA处理。与基线期相比,仅在第二至第五暴露危险期药物过量入院的风险显著降低[相对发生率(RI)=0.86,95%置信区间(CI)=0.80~0.99;0.89,95%CI=0.80~0.99;0.86,95%CI=0.77~0.96;0.88,95%CI=0.78~0.99].对于非病毒注射相关的入院,首先风险降低了,第三和第四暴露危险期(RI=0.76,95%CI=0.64-0.90;0.75,95%CI=0.62-0.90;0.79,95%CI=0.66-0.96).没有证据表明在治疗结束后的任何时期内DRM风险降低。
结论:在苏格兰注射毒品的人中,直接作用的抗病毒治疗似乎与一个小,药物相关住院风险的非持久降低,但不是药物相关的死亡率。直接抗病毒治疗,尽管对肝脏疾病有很高的疗效,似乎没有提供减少其他与药物相关的健康危害的灵丹妙药。
Direct-acting antiviral (DAA) treatment has an established positive effect on liver outcomes in people with hepatitis C infection; however, there is insufficient evidence regarding its effects on the \'extra-hepatic\' outcomes of drug-related hospitalization and mortality (DRM) among people who inject drugs (PWID). We investigated associations between these outcomes and DAA treatment by comparing post-treatment to baseline periods using a within-subjects design to minimize selection bias concerns with cohort or
case-control designs.
This was a self-controlled
case-series study.
Scotland, 1 January 2015-30 November 2020.
The study population of non-cirrhotic, DAA-treated PWID was identified using a data set linking Scotland\'s hepatitis C diagnosis, HCV clinical databases, national inpatient/day-
case hospital records and the national deaths register. Three principal outcomes (drug overdose admission, non-viral injecting related admission and drug-related mortality) were defined using ICD codes.
Self-controlled
case-series methodology was used to estimate the relative incidence (RI) of each outcome associated with time on treatment and up to six 90-day exposure risk periods thereafter.
A total of 6050 PWID were treated with DAAs in the sampling time-frame. Compared with the baseline period, there was a significantly lowered risk of a drug overdose hospital admission in the second to fifth exposure risk periods only [relative incidence (RI) = 0.86, 95% confidence interval (CI) = 0.80-0.99; 0.89, 95% CI = 0.80-0.99; 0.86, 95% CI = 0.77-0.96; 0.88, 95% CI = 0.78-0.99, respectively]. For non-viral injecting-related admission, there was a reduced risk in the first, third and fourth exposure risk periods (RI = 0.76, 95% CI = 0.64-0.90; 0.75, 95% CI = 0.62-0.90; 0.79, 95% CI = 0.66-0.96, respectively). There was no evidence for reduced DRM risk in any period following treatment end.
Among people who inject drugs in Scotland, direct-acting antiviral treatment appears to be associated with a small, non-durable reduction in the risk of drug-related hospital admission, but not drug-related mortality. Direct-acting antiviral therapy, despite high effectiveness against liver disease, does not appear to offer a panacea for reducing other drug-related health harms.