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

Authors

  • Amy Matser,

    Corresponding author
    1. Cluster of infectious diseases, Amsterdam Public Health Service, Amsterdam, the Netherlands
      Amy Matser, Cluster of Infectious Diseases, Amsterdam Public Health Service, Postbox 2200, 1000 CE Amsterdam, The Netherlands. E-mail: amatser@ggd.amsterdam.nl
    Search for more papers by this author
  • Anouk Urbanus,

    1. Cluster of infectious diseases, Amsterdam Public Health Service, Amsterdam, the Netherlands
    Search for more papers by this author
  • Ronald Geskus,

    1. Cluster of infectious diseases, Amsterdam Public Health Service, Amsterdam, the Netherlands
    2. Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre (AMC), Amsterdam, the Netherlands
    Search for more papers by this author
  • Mirjam Kretzschmar,

    1. Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht (UMCU), Utrecht, the Netherlands
    2. Centre for Infectious Disease Control, National Institute of Public Health and the Environment (RIVM), Bilthoven, the Netherlands
    Search for more papers by this author
  • Maria Xiridou,

    1. Centre for Infectious Disease Control, National Institute of Public Health and the Environment (RIVM), Bilthoven, the Netherlands
    Search for more papers by this author
  • Marcel Buster,

    1. Epidemiology documentation, and health promotion, Amsterdam Public Health Service, Amsterdam, the Netherlands
    Search for more papers by this author
  • Roel Coutinho,

    1. Centre for Infectious Disease Control, National Institute of Public Health and the Environment (RIVM), Bilthoven, the Netherlands
    2. Centre for Infection and Immunology Amsterdam (CINIMA), Department of Internal Medicine, Academic Medical Centre (AMC), Amsterdam, the Netherlands
    Search for more papers by this author
  • Maria Prins

    1. Cluster of infectious diseases, Amsterdam Public Health Service, Amsterdam, the Netherlands
    2. Centre for Infection and Immunology Amsterdam (CINIMA), Department of Internal Medicine, Academic Medical Centre (AMC), Amsterdam, the Netherlands
    Search for more papers by this author

Amy Matser, Cluster of Infectious Diseases, Amsterdam Public Health Service, Postbox 2200, 1000 CE Amsterdam, The Netherlands. E-mail: amatser@ggd.amsterdam.nl

ABSTRACT

Aims  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.

Design  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.

Setting  IDU population of Amsterdam.

Measurements  HCV infection simulated from its acute phase to HCV-related liver disease (i.e. decompensated cirrhosis and hepatocellular carcinoma).

Findings  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.

Ancillary