Efficacy of Direct-acting Antivirals for Chronic Hepatitis C Virus Infection in People Who Inject Drugs or Receive Opioid Substitution Therapy: A Systematic Review and Meta-analysis

Abstract

Background Treatment uptake for hepatitis C virus (HCV) infection in people who inject drugs (PWID) and patients on opioid substitution therapy (OST) is still low despite treatment guidelines that advocate the use of direct-acting antivirals (DAAs) in all patients. Our aim in this review was to investigate treatment outcomes among PWID and patients on OST in comparison to control cohorts. Methods A search of Embase, Medline, PubMed, and Web of Science (from October 2010 to March 2018) was conducted to assess sustained virologic response (SVR), discontinuation rates, adherence, and HCV reinfection in PWID and patients on OST. Results We identified 11 primary articles and 12 conference abstracts comprising 1702 patients on OST, 538 PWID, and 19 723 patients who served as controls. Among patients on OST, the pooled SVR was 90% (95% confidence interval [CI], 87% to 93%) and pooled treatment discontinuation rate was 7% (95% CI, 4% to 11%). Similarly, the pooled SVR was 88% (95% CI, 80% to 93%) in PWID and the pooled treatment discontinuation rate was 9% (95% CI, 5% to 15%). There was no significant difference regarding pooled rates of SVR, adherence, and discontinuation between patients on OST and controls as well as between PWID and controls. HCV reinfection rates among patients on OST ranged from 0.0 to 12.5 per 100 person-years. Conclusions HCV treatment outcomes in PWID and patients on OST are similar to those in patients without a history of injecting drugs, supporting current guideline recommendations to treat HCV in these patient populations.

Directly observed therapy for HCV with glecaprevir/pibrentasvir alongside opioid substitution in people who inject drugs—First real world data from Austria

“…The included PWIDs showed excellent adherence to therapy with only a very limited number of scheduled DAA-ingestions being missed and, most importantly, an SVR rate of 98.6%-which was in fact similar to the SVR rate of 98.6% achieved in patients with presumed "excellent compliance" with G/P self-administration. The observed excellent safety profile of G/P as well as the high SVR rates that did not relevantly deviate from the treatment outcomes in patients without a history of IDU go in line with literature and support the recommendations of broad access to HCV treatment [35,36].…”

“…Various studies have shown that DAA therapy for HCV is safe in PWIDs, even in the presence of ongoing IDU and/or OST, and leads to excellent cure rates that do not deviate much from patients without a history of IDU [35,36]. We hypothesized that directly observed DAA therapy along with OST under the supervision of medical staff at local pharmacies or lowthreshold facilities would further increase DAA adherence and improve HCV treatment outcomes in PWIDs on stable OST with or without ongoing IDU.…”

High dropout rate from aftercare program of antihepatitis C therapy for patients with history of injection drug use

“…Our results are consistent with previous reports from other countries. 21,22 A systematic review reported a 5-year HCV recurrence rate of 10.67%, driven mainly by reinfection in IDUs or prisoners. 7 To eliminate HCV in PWID, long-term follow-up after DAA therapy is necessary.…”

How effective and how durable is DAA‐therapy in HCV‐infected drug users?

“…Moreover, the discontinuation rate in recent PWID was extremely low (2%). In fact, other groups have confirmed low discontinuation rates in PWID that were not different to non‐PWID populations with DAA treatment …”