Onsite treatment of HCV infection with direct acting antivirals within an opioid treatment program

Butner, Jenna; Gupta, Neil; Fabian, Chris; Henry, Susan; Shi, Julia; Tetrault, Jeanette M.

doi:10.1016/j.jsat.2016.12.014

Cited by 63 publications

(60 citation statements)

References 21 publications

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“…In the ITT analysis we clearly observed lower SVR12 rates: 79.9% of our population achieved SVR12, with the absence of HCV RNA testing after treatment completion being the main reason for the lower SVR12. Our data are in accordance with other real-world studies that reported SVR12 rates ranging between 80-87% [19,20,27]. Furthermore, the percentage of 10.3% LTFU after treatment completion was similar to that in several real-world studies [12,19,27], although others [18,20,21] reported significantly lower LTFU rates (0.6-2%).…”

Section: Discussionsupporting

confidence: 91%

“…Our data are in accordance with other real-world studies that reported SVR12 rates ranging between 80-87% [19,20,27]. Furthermore, the percentage of 10.3% LTFU after treatment completion was similar to that in several real-world studies [12,19,27], although others [18,20,21] reported significantly lower LTFU rates (0.6-2%). The different LTFU rates across the studies might be related to the context of treatment delivery and follow up (i.e., frequency of study visits, engagement in active follow up by study personnel, patientfriendly schedule of appointments), the special characteristics of the PWID treated and the definition of LTFU in the real-world setting.…”

Section: Discussionsupporting

confidence: 91%

“…The efficacy of DAA therapy in PWID with HCV infection has been examined in 2 large prospective studies, in a number of post hoc analyses and in several real world studies [11][12][13]16,17,19,20,[27][28][29]. In the prospective cohorts, ITT SVR12 rates were 94% and 92%, with 3% of the patients being LTFU [13,17].…”

Section: Discussionmentioning

confidence: 99%

“…However, there is a large body of evidence that DAA therapy in PWID offers sustained virological response rates 12 weeks after treatment completion (SVR12) similar to those in non-PWID populations [11][12][13][14][15][16]. A reasonable concern in a marginalized population is compliance with treatment; indeed, although the proportion of patients lost to follow up (LTFU) is small in randomized clinical trials [13,17], data from real-world settings are scanty and conflicting [12,[18][19][20][21]. The rate of LTFU and the factors that may affect engagement with treatment and follow up will add crucial information to improve HCV service delivery and treatment.…”

Section: Introductionmentioning

confidence: 99%

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

Koustenis

Anagnostou

Kranidioti

et al. 2020

aog

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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

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Koustenis

Anagnostou

Kranidioti

et al. 2020

aog

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“…This approach substantially improved adherence [ 39 ]. Moreover, HCV treatment outcomes are not affected by opioids [ 40 ]. Thus, considering the recently extended access to IFN-free regimens, such programs might decrease the incidence of HCV among patients with IVDA [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

Non-invasive liver fibrosis assessment and HCV treatment initiation within a systematic screening program in HIV/HCV coinfected patients

Chromy

Schwabl

Bucsics

et al. 2017

Wien Klin Wochenschr

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SummaryBackground and aimHepatitis C virus (HCV) therapy should be considered without delay in all patients with significant (SIGFIB) or advanced liver fibrosis (ADVFIB). We aimed to investigate the rates of treatment initiation with interferon-free regimens within a screening program for SIGFIB/ADVFIB in human immunodeficiency virus/HCV coinfected patients (HIV/HCV).MethodsThe FIB-4 was calculated in all HIV/HCV from 2014–2016. HIV/HCV were counselled by the HIV clinic and referred to the Division of Gastroenterology and Hepatology for transient elastography (TE) and evaluation for HCV therapy. Patients were stratified by FIB-4 of 7.1 kPa/>9.5 kPa, respectively.ResultsAmong 1348 HIV+ patients, 16% (210/1348) had detectable HCV-RNA. One hundred HIV/HCV had a FIB-4 ≥1.45. Among these, 57% (57/100) underwent TE. The majority of these patients had SIGFIB (75%; 43/57) or ADVFIB (37%; 21/57), however, interferon-free treatment was initiated in only 56% (24/43).In addition, fifty-two percent (57/110) of HIV/HCV with FIB-4 <1.45 underwent TE. Interestingly, 40% (23/57) and 18% (10/57) of these patients showed SIGFIB or even ADVFIB, respectively, and 78% (18/23) finally received interferon-free treatment. Overall, only 20% (42/210) of HIV/HCV received interferon-free treatment.ConclusionFIB-4 was not useful for ruling out SIGFIB/ADVFIB in our cohort of HIV/HCV. Treatment was initiated only in a small proportion (20%) of HIV/HCV during the first 2 years of interferon-free treatment availability, although the observed proportion of patients with SIGFIB (assessed by TE) was considerably higher (58%). Thus, it requires the ongoing combined efforts of both HIV and HCV specialists to increase treatment uptake rates in this special population.Electronic supplementary materialThe online version of this article (doi: 10.1007/s00508-017-1231-x) contains supplementary material, which is available to authorized users.

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The Impact of Direct‐Acting Antiviral Therapy on End‐Stage Liver Disease Among Individuals with Chronic Hepatitis C and Substance Use Disorders

et al. 2021

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BaCKgRoUND aND aIMS: Our aim was to evaluate the impact of direct-acting antivirals (DAAs) on decompensated cirrhosis (DCC) and HCC in patients with chronic HCV and substance use disorder (SUD) compared with those without an SUD. appRoaCH aND ReSUltS: This retrospective cohort study used the MarketScan database (2013)(2014)(2015)(2016)(2017)(2018) to identify 29,228 patients with chronic HCV, where 22% (n = 6,385) had ≥1 SUD diagnosis. The inverse probability of treatment weighted multivariable Cox proportional hazard models were used to compare the risk of developing DCC and HCC. Among the those who were noncirrhotic, treatment reduced the DCC risk among SUD (adjusted hazard ratio [aHR] 0.13; 95% CI, 0.06-0.30) and non-SUD (aHR 0.11; 95% CI, 0.07-0.18), whereas the risk for HCC was not reduced for the SUD group (aHR 0.91; 95% CI, 0.33-2.48). For those with cirrhosis, compared with patients who were untreated, treatment reduced the HCC risk among SUD (aHR, 0.33; 95% CI, 0.13-0.88) and non-SUD (aHR, 0.40; 95% CI, 0.25-0.65), whereas the risk for DCC was not reduced for the SUD group (aHR, 0.64; 95% CI, 0.37-1.13). Among patients with cirrhosis who were untreated, the SUD group had a higher risk of DCC (aHR, 1.52; 95% CI, 1.03-2.24) and HCC (aHR, 1.69; 95% CI, 1.05-2.72) compared with non-SUD group.CoNClUSIoNS: Among the HCV SUD group, DAA treatment reduced the risk of DCC but not HCC for those who were noncirrhotic, whereas DAA treatment reduced the risk of HCC but not DCC for those with cirrhosis. Among the nontreated, patients with an SUD had a significantly higher risk of DCC and HCC compared with those without an SUD. Thus, DAA treatment should be considered for all patients with HCV and an SUD while also addressing the SUD. (Hepatology 2021;74:566-581). HCV infection is the most common chronic bloodborne infection in the United States and is a substantial cause of morbidity and mortality. In the United States, individuals with a substance use disorder (SUD) are disproportionately affected by HCV. In fact, injection drug use, which is the most common risk factor for contracting HCV, accounts for ~75% of newly acquired cases of HCV and ~50% of cases of chronic HCV infection. (1,2) In addition, the majority of patients infected with HCV also have an alcohol use disorder, which is highly associated with concomitant use of illegal substances, leading to an increased risk for HCV.

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Onsite treatment of HCV infection with direct acting antivirals within an opioid treatment program

Cited by 63 publications

References 21 publications

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

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

Non-invasive liver fibrosis assessment and HCV treatment initiation within a systematic screening program in HIV/HCV coinfected patients

The Impact of Direct‐Acting Antiviral Therapy on End‐Stage Liver Disease Among Individuals with Chronic Hepatitis C and Substance Use Disorders

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