Intravenous drug use: not a barrier to achieving a sustained virological response in HCV infection

Abstract

Hepatitis C virus (HCV) is commonly transmitted by intravenous drug use (IDU) but drug users are under represented in many treatment cohorts, this is because of the assumption of lowered treatment success. We assessed HCV treatment outcomes in active intravenous drug users and patients on opiate substitution therapy. The Tayside HCV treatment database was retrospectively analysed for consecutively treated patients based on risk factor for acquisition of HCV. Primary end point was sustained virological response (SVR). Two hundred and ninety-one consecutively treated patients were assessed. The overall SVR rate was 55.3%. The SVR rates by risk factor were; Non-IDU 61.4%, Ex-IDU 54.8% and Active IDU 47.1% (P = n/s). In the groups G1 patients SVR was; Non-IDU 52.7%, Ex-IDU 30.7% and active IDU 35.4% (P = n/s). In the non-G1 patients: non-IDU 65.1%, Ex-IDU 76.7% and active IDU 53.5%. Ex-IDU had a significantly better SVR than active IDU, other differences were not significant. Our results demonstrate that SVR rates in the active drug users and those on opiate substitution therapy can be achieved which are comparable with non-IDU infected individuals. Intravenous drug use in those engaged with treatment services should not be seen as a barrier to treatment of HCV.

HCVtreatment rates and sustained viral response among people who inject drugs in sevenUKsites: real world results and modelling of treatment impact

“…There are a growing number of studies that have shown that HCV treatment can be delivered to PWID with little loss in SVR compared to non or ex‐PWID and also that treatment can be expanded among PWID, especially if linked to OST . Our model projections (based on real data) show that relatively high treatment rates can be achieved (at >20 per 1000 PWID) and could be sufficient to demonstrate ‘treatment as prevention’ in many settings.…”

Recommendations for the management of hepatitis C virus infection among people who inject drugs

“…Recent drug use at treatment initiation has limited impact on adherence (Grebely, Matthews, Hellard, et al, 2011; Manolakopoulos et al, 2010; Marcellin et al, 2011; Sola et al, 2006; Sylvestre & Clements, 2007; Wilkinson et al, 2009), treatment completion (Grebely, Matthews, Hellard, et al, 2011; Hellard et al, 2009;Manolakopoulos et al, 2010; Papadopoulos et al, 2010), or SVR (Aspinall et al, 2013; Bruggmann et al, 2008; Dore et al, 2010; Grebely, Raffa, et al, 2007; Lindenburg et al, 2011; Manolakopoulos et al, 2010; Papadopoulos et al, 2010; Sasadeusz et al, 2011; Sylvestre et al, 2005). Some studies have reported lower treatment completion in those with recent drug use at treatment initiation (Hellard et al, 2009; Jafferbhoy et al, 2012). HCV treatment does not have an impact on drug dependency treatment or increase druguse (Mauss et al,2004; Van Thiel et al, 2003).…”

“…Successful HCV treatment studies among PWID challenged this paradigm (Alvarez-Uria, Day, Nasir, Russell, & Vilar, 2009; Aspinall et al, 2013; Backmund, Meyer, Von Zielonka, & Eichenlaub, 2001; Bruggmann et al, 2008; Dalgard, 2005; Dimova et al, 2013; Dore et al, 2010; Grebely, Genoway, et al, 2007; Grebely et al, 2010; Grebely, Raffa, et al, 2007; Guadagnino et al, 2007; Hellard, Sacks-Davis, & Gold, 2009; Jack, Willott, Manners, Varnam, & Thomson, 2009; Jafferbhoy et al, 2012; Jeffrey et al, 2007; Lindenburg et al, 2011; Manolakopoulos et al, 2010; Martinez et al, 2010; Matthews, Kronborg, & Dore, 2005; Mauss, Berger, Goelz, Jacob, & Schmutz, 2004; Melin et al, 2010; Neri et al, 2002; Papadopoulos, Gogou, Mylopoulou, & Mimidis, 2010; Robaeys et al, 2006; Sasadeusz et al, 2011; Schaefer et al, 2003, 2007; Sylvestre, 2002; Sylvestre, Litwin, Clements, & Gourevitch, 2005; Van Thiel, Anantharaju, & Creech, 2003; Van Thiel et al, 1995; Waizmann & Ackermann, 2010; Wilkinson et al, 2009). International guidelines from the American Association for the Study of Liver Disease (AASLD)/Infectious Diseases Society of America (IDSA), the European Study for the Association of the Liver (EASL), the International Network for Hepatitis in Substance Users and the World Health Organization now all recommend treatment for HCV infection among PWID (AASLD/IDSA, 2015; European Association for Study of Liver, 2014; Robaeys et al, 2013; WHO, 2014).…”

Influence of Healthcare-Associated Factors on the Efficacy of Hepatitis C Therapy

“…On the other hand, IVDUs often share many factors of good response to therapy, such as young age, short duration of disease, and HCV genotype 3 infection. Moreover, different clinical studies suggest that IVDU can be treated successfully also when active use of drugs has been withdrawn for only a short period of time [16, 67, 68]. Thus, more effective guidelines contain less restrictive recommendations.…”