Belgian experience with direct acting antivirals in people who inject drugs

Abstract

PWID, especially active users, are underserved for DAA treatment in real life in Belgium. Reimbursement criteria based on fibrosis stage make it difficult to treat PWID. Treatment adherence is similar in PWID and the general population, even in patients with active abuse. DAA were safe and effective in PWID despite the higher prevalence of difficult-to-treat genotypes. Based on these data more efforts to treat PWID are needed and policy changes are necessary to reach the WHO targets.

Effectiveness of Ledipasvir/Sofosbuvir and Sofosbuvir/Velpatasvir in People Who Inject Drugs and/or Those in Opioid Agonist Therapy

“…Studies of individuals not injecting drugs have shown similar higher SVR rates in clinical trials and real‐world settings, where SVR rates of approximately 90% to 95% have been reported . Available data from small previous studies and the recent reviews assessing treatment outcomes among PWID have shown high SVR rates; these studies include a trial among people on OAT using elbasvir/grazoprevir, which showed an SVR of 95%, and a recent trial on current PWID using SOF/VEL, which showed an SVR of 94% . However, the study population in those trials was selective, as people with HIV were not included and study participants were followed more closely; therefore, loss to follow‐up was lower.…”

“…However, PWID participating in RCTs are very different from those in a real‐world situation, and concerns remain about compliance, loss to follow‐up, and treatment effectiveness . Although data on the treatment of PWID from real‐world settings are emerging, many of these studies are small and enroll patients from single practice or community programs, with the exception of a recent German study . As such, broader population‐based data on the treatment of PWID with DAAs are limited.…”

The risk of early occurrence and recurrence of hepatocellular carcinoma in hepatitis C‐infected patients treated with direct‐acting antivirals with and without pegylated interferon: A Belgian experience

“…We performed a national, retrospective cohort study in 15 hospitals, distributed across Belgium. Data were available from two studies which used the same methodology, focusing on the outcome of DAA with and without PEG‐IFN in HCV‐infected PWID vs non‐PWID . Data were collected from the medical patient files.…”

Prevalence of HCV among people who inject drugs in Brussels—a respondent-driven sampling survey

“…Over the last 15 years, global mortality related to chronic HCV infection has steadily increased to over 400,000 deaths annually [1]. This contrasts with the declining number of deaths estimated from other infectious diseases such as HIV, tuberculosis, and malaria [1], making HCV one of the main causes of chronic liver disease and mortality worldwide [8].…”

“…People who inject drugs (PWID) are at a high risk of being infected by the virus [8,9], and injecting drug use is nowadays the main mode of HCV transmission [5]. The number of countries with studies quantifying the prevalence of HCV infection among PWID is increasing [10].…”