People who inject drugs (PWID) are often affected by physical and psychological diseases and prone to co-medication. In Germany, about 50% of PWID are on opioid substitution therapy (OST). Comprehensive data on pharmacotherapy in these patients may help to select antiviral therapy against hepatitis C virus (HCV) infections and avoid drug–drug interactions (DDIs). We compared co-medication profiles based on statutory health insurance prescriptions (IQVIA database) of PWID (n = 16,693), OST (n = 95,023) and treated HCV patients (n = 7886). Potential DDIs with the most widely used HCV direct-acting agents (Sofosbuvir/Velpatasvir, Glecaprevir/Pibrentasvir and Elbasvir/Grazoprevir) were evaluated based on the Liverpool DDI database. Co-medication was present in 57% of PWID, 57% of OST, 44% of patients on HCV therapy and 46% in a subgroup receiving OST+HCV therapy (n = 747 of 1613). For all groups, co-medication belonging to ATC-class N (nervous system) was most commonly prescribed (in 75%, 68%, 41% and 62% of patients, respectively). Contraindications (i.e., DDIs precluding HCV therapy) were infrequent (0.4–2.5% of co-medications); potential DDIs with HCV therapies were shown for 13–19% of co-medications, namely for specific substances including some analgesics, antipsychotics, anticoagulants, lipid lowering drugs and steroids. In conclusion, concomitant pharmacotherapy is common and clinically relevant when treating HCV infection in PWID.
infusion with new partial seizure activity, a dense rightsided spastic hemiplegia (power 0/5), complete aphasia, and inability to follow commands. The swallow also deteriorated, resulting in aspiration pneumonia, so a feeding tube was placed. MRI showed further progression with new lesional enhancement and increased midline shift. There was a mild elevation of CSF protein (0.62 g/l) and white cells (7 cells/ml).Although there was an ongoing decline following the first infusion, the trajectory of rapid deterioration slowed and a gradual improvement was observed following the second infusion of pembrolizumab. The patient began to speak again using short phrases, her right-sided weakness improved (power 2/5), and she regained her swallow sufficiently to allow a normal oral diet. The steroids were weaned then stopped. She continued to improve, and by the time of the fourth pembrolizumab infusion at 25 weeks, she was able to use a wheelchair, speak in short sentences, and use a low-tech communication board. This coincided with further radiological improvement. JCV DNA remained detectable at a low level in the CSF. Her CD4 þ cell count improved to 72 cells/ml (8%) after 1 year of ART.
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