Direct-acting antiviral treatment for chronic hepatitis C in people who use drugs in a real-world setting

Abstract

Background Direct-acting antivirals (DAAs) offer high cure rates in people who inject drugs (PWID) with hepatitis C virus (HCV) infection. There are concerns regarding lower response rates among PWID in real life. We evaluated the outcome of DAA therapy in PWID in a real-world setting and the factors that affect it. Methods We performed a retrospective analysis of 174 PWID with chronic hepatitis C who started DAAs in a Greek liver clinic in collaboration with an addiction program. Patients who did not return for reassessment were considered as lost to follow up (LTFU). A logistic regression model was used to assess factors associated with a sustained virological response 12 weeks after treatment completion (SVR12) and LTFU. Results Patients' mean age was 48±9.2 years and 91/174 (52.3%) were attending opioid substitution treatment programs. Overall, 144/174 (82.8%) patients completed therapy and presented for SVR12 testing, 8/174 (4.6%) did not complete treatment and 22/174 (12.6%) were LTFU. Overall SVR12 was 79.9% (139/174). For those with an available SVR12 test the response rate reached 96.5% (139/144). Regression analysis did not indicate any significant association between patient characteristics and SVR12. Age <45 years and genotype 3 were independent predictors of LTFU. Parallel use was found to have a trend towards LTFU. Conclusions HCV treatment by hepatologists and addiction specialists is feasible, effective and safe in a real-world setting. However, as 12% of patients appear to be LTFU, more emphasis should be placed on interventions guaranteeing follow up for SVR testing and general care. Keywords Direct-acting antivirals, hepatitis C virus infection, people who inject drugs, sustained virological response, lost to follow up

Glecaprevir/pibrentasvir for 8 weeks in patients with compensated cirrhosis: Safety and effectiveness data from the German Hepatitis C‐Registry

“…Notably, a high number of LTFU patients had co‐morbidities of drug abuse, drug substitution therapy and psychiatric disorders. In other real‐world DAA studies, similar SVR12 differences in PP and ITT populations were observed in patients who use drugs and patients on opioid substitution therapy, due to a high number of patients LTFU 13‐16 . Whilst clinical trial data demonstrated high SVR12 rates in these vulnerable patients, failure to report for SVR results continues to remain a barrier for HCV care in real‐world settings 13‐15,17,18 .…”

“…In other real‐world DAA studies, similar SVR12 differences in PP and ITT populations were observed in patients who use drugs and patients on opioid substitution therapy, due to a high number of patients LTFU 13‐16 . Whilst clinical trial data demonstrated high SVR12 rates in these vulnerable patients, failure to report for SVR results continues to remain a barrier for HCV care in real‐world settings 13‐15,17,18 . Whilst this does not indicate withholding treatment from these patient populations, they may require additional support measures to prevent LTFU, achieve SVR, and reach World Health Organization (WHO) elimination targets.…”

Phylogenetic and Phylodynamic Analyses of HCV Strains Circulating among Patients Using Injectable Drugs in Central Italy

“…DAAs as treatment options against all of the HCV genotypes have been crucial in curtailing the spread of the virus. Their use has led to a greater than 90% cure rate even among PWUD [ 50 , 51 ]. Therefore, a focus on treating PWUD communities with DAAs could be highly effective in controlling the transmission of HCV among this vulnerable population.…”

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“…While there has been evidence for lower response rates to DAA treatment in HCV populations with parallel injectable recreational drug use, a 2020 study led by Koustenis et al [ 42 ] offers real-world data that sustained virological response to DAAs is possible in high-risk patients who inject drugs[ 42 ]. This is in keeping with established trends revealing similar treatment responses in these higher-risk populations to that of the general population[ 42 ]. However, adherence and loss to follow-up remain ongoing concerns among high-risk populations, and during the study, over 10% of patients who inject drugs were lost to follow-up during or after treatment[ 42 ].…”

“…However, adherence and loss to follow-up remain ongoing concerns among high-risk populations, and during the study, over 10% of patients who inject drugs were lost to follow-up during or after treatment[ 42 ]. The risk of being lost to follow-up was correlated with several factors, including younger age and parallel recreational drug use[ 42 ].…”