Hepatitis C treatment and reinfection surveillance among people who inject drugs in a low-threshold program in Oslo, Norway

Midgard, Håvard; Ulstein, Kjersti; Backe, Øystein; Foshaug, Tarjei; Sørli, Hanne; Vennesland, Kristin; Nilssen, David; Dahl, Elin Hoffmann; Finbråten, Ane‐Kristine; Wüsthoff, Linda Elise Couëssurel; Dalgård, Olav

doi:10.1016/j.drugpo.2021.103165

Cited by 21 publications

(57 citation statements)

References 23 publications

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“…Finally, we reported an overall reinfection rate after successful HCV treatment of 1.25/100 PY. Many authors have reported higher reinfection rates among PWID compared with our cohort [26,[29][30][31]. This may be attributed to the high heterogeneity of populations across studies, including differences in risk profile, ongoing injecting drugs use, and multiple co-occurring conditions, such as alcohol abuse and HIV co-infection.…”

Section: Discussionmentioning

confidence: 62%

Model of Care for Microelimination of Hepatitis C Virus Infection among People Who Inject Drugs

Foschi

Borghi

Grassi

et al. 2021

JCM

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Background: People who inject drugs (PWID) are the largest group at risk for HCV infection. Despite the direct acting antivirals (DAA) advancements, HCV elimination has been hindered by real-life difficulties in PWID. Aims: This study aimed to assess the impact of a multidisciplinary intervention strategy where HCV screening, treatment and follow-up were performed at the same location on efficacy and safety of DAA-therapy in real-life PWID population. Methods: All HCV-infected PWID referred to five specialized outpatient centers for drug addicts (SerDs) in Northern Italy were prospectively enrolled from May 2015 to December 2019. Hepatologists and SerDs healthcare workers collaborated together in the management of PWID inside the SerDs. Sustained virologic response (SVR), safety of treatment, proportion of patients lost to follow-up and reinfection rate were evaluated. Results: A total of 358 PWID started antiviral treatment. About 50% of patients had advanced fibrosis/cirrhosis, 69% received opioid substitution treatment, and 20.7% self-reported recent injecting use. SVR was achieved in 338 (94.4%) patients. Two patients died during treatment; one prematurely discontinued, resulting in a non-responder; twelve were lost during treatment/follow-up; and five relapsed. No serious adverse events were reported. SVR was lower in recent PWID than in former ones (89.2% vs. 95.8%; p = 0.028). Seven reinfections were detected, equating to an incidence of 1.25/100 person-years. Reinfection was associated with recent drug use (OR 11.07, 95%CI 2.10–58.38; p = 0.005). Conclusion: Our embedded treatment model could be appropriate to increase the linkage to care of HCV-infected PWID. In this setting, DAA regimens are well tolerated and highly effective, achieving a lower rate of reinfection.

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Section: Discussionmentioning

confidence: 62%

Model of Care for Microelimination of Hepatitis C Virus Infection among People Who Inject Drugs

Foschi

Borghi

Grassi

et al. 2021

JCM

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“…The researchers observed a reinfection prevalence of 4.5% and an overall reinfection rate of 3.1/100 PY [22]. In a recent study in Norway, the prevalence of HCV reinfection was 2.7% (8/297) and the incidence 2.60/100 PY (95% CI 1.12-5.11) [16]. Also, in Scotland, reinfection in people living with HIV (80% PWID) appears to be notably low, with an incidence of 0.2/100 PY [23].…”

Section: Discussionmentioning

confidence: 95%

“…Reinfection was defined as HCV RNA recurrence following virologic response at the end of treatment [16]. To optimize the follow-up of reinfection in PWID, the gaps in current care were exposed.…”

Section: Outcomementioning

confidence: 99%

“…DAA treatment is also effective in individuals who have received opioid agonist treatment (OAT) and active PWID. Nevertheless, providing HCV care in this population can be challenging because of the loss of follow-up and reinfection after successful treatment in cases of persistent risk behavior [16].…”

Section: Introductionmentioning

confidence: 99%

“…In 2017, the reinfection rate in one Belgian addiction care center was 2.6/100 PY over a follow-up time of 39 PY [18]. Although it is acknowledged that regular HCV RNA testing after treatment in PWID is an indispensable part of any elimination strategy, the feasibility of monitoring for reinfection and retreatment has been little explored [16]. Also, there is no national HCV registry in Belgium, making it difficult to follow patients after treatment.…”

Section: Introductionmentioning

confidence: 99%

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Hepatitis C reinfection in former and active injecting drug users in Belgium

et al. 2021

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Background There is currently no systematic screening for hepatitis C (HCV) reinfection in people who inject drugs (PWID) after treatment in Belgium. However, in a recent meta-analysis, the overall HCV reinfection rate was 5.9/100 person-years (PY) among PWID. Accordingly, this study was undertaken to investigate the reinfection rate in former and active PWID who achieved the end of treatment response after direct-acting antiviral (DAA) treatment in Belgium. Methods This observational cross-sectional study recruited individuals with a history of injecting drug use who had achieved the end of treatment response to any DAA treatment between 2015 and 2020. Participants were offered a post-treatment HCV RNA test. Results Eighty-five potential participants were eligible to participate and contacted, of whom 60 participants were enrolled in the study with a median age of 51.0 (IQR 44.3–56.0) years; it was reported that 23.3% continued to inject drugs intravenously after DAA treatment. Liver cirrhosis was present in 12.9%. The majority had genotype 1a (51.7%) or genotype 3 (15.0%) infection. We detected no reinfections in this study population. The total time patients were followed up for reinfection in the study was 78.5 PY (median 1.0 years IQR 0.4–2.0). Conclusion Reinfection after successful treatment with DAA initially appears to be very low in Belgian PWID. Therefore, efforts should be made to screen individuals with persistent risk behaviors for reinfection systematically. In addition, a national HCV registry should be established to accurately define the burden of HCV infection and reinfection in Belgium and support the elimination of viral hepatitis C in Europe. Trial registration clinicaltrials.gov NCT04251572, Registered 5 Feb 2020–Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04251572.

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Progress and remaining challenges to address hepatitis C, other infectious diseases, and drug-related harms to improve the health of people who use drugs

Grebely

Collins

Artenie

et al. 2021

International Journal of Drug Policy

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Hepatitis C treatment and reinfection surveillance among people who inject drugs in a low-threshold program in Oslo, Norway

Cited by 21 publications

References 23 publications

Model of Care for Microelimination of Hepatitis C Virus Infection among People Who Inject Drugs

Model of Care for Microelimination of Hepatitis C Virus Infection among People Who Inject Drugs

Hepatitis C reinfection in former and active injecting drug users in Belgium

Progress and remaining challenges to address hepatitis C, other infectious diseases, and drug-related harms to improve the health of people who use drugs

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