Direct-Acting Antivirals Effective for HCV in People Who Inject Drugs
Results indicate that opioid agonist treatment and heroin-assisted treatment programs should offer integrated HCV treatment to improve outcomes in this patient population.
Direct-acting antivirals (DAAs) can effectively treat chronic hepatitis C virus (HCV) among people who inject drugs and can be integrated in opioid agonist treatment (OAT) or heroin-assisted treatment (HAT) with high rates of sustained virological response (SVR), according to results published in the International Journal of Drug Policy.
These results indicate that OAT and HAT programs should offer integrated HCV treatment to improve outcomes in this patient population.
The study included participants who had been treated with DAAs between October 2014 and August 2017 in the Arud outpatient clinics in Zurich, Switzerland (n=64). The researchers collected data on patient characteristics, treatment characteristics, and substance use. The primary outcomes were SVR by intention-to-treat (ITT) and modified ITT (mITT) analyses, excluding participants with missing SVR data.
Of 64 total participants, 66% (n=42) were in OAT and 34% (n=22) were in HAT. In terms of substance use, 41% (n=26) of participants reported harmful alcohol use and 14% (n=9) reported injecting drug use during DAA treatment.
All participants completed the treatment, with 92.2% (n=59) achieving ITT SVR. Only 2 participants had virological failure, and another 3 were lost to follow-up between the end of treatment and SVR12 visit. Excluding those 3 participants, the results indicated a mITT SVR rate of 96.7%.
"DAA treatment for hepatitis HCV is feasible and effective for [people who inject drugs] when performed on-site in OAT and HAT with a supportive, flexible and nonjudgmental approach," the researchers wrote. "HCV treatment can be successfully performed by trained primary care physicians experienced in working in the field of addiction medicine."
Scherz N, Bruggmann P, Brunner N. Direct-acting antiviral therapy for hepatitis C infection among people receiving opioid agonist treatment or heroin assisted treatment. Int J Drug Policy. 2018;62:74-77.