Response to direct-acting antiviral therapy among ongoing drug users and people receiving opioid substitution therapy

Hepatitis C Guidance 2019 Update: American Association for the Study of Liver Diseases–Infectious Diseases Society of America Recommendations for Testing, Managing, and Treating Hepatitis C Virus Infection

“…Several studies demonstrate that treatment-committed individuals in this disproportionately affected population achieve sustained virologic response (SVR) rates with DAA therapy comparable to those without known, current substance use. (73,(132)(133)(134)(135)(136)(137)(138)(139) The universal treatment recommendation represents a principal tenet of the HCV guidance along with newly recommended universal hepatitis C screening of adults. The HCV guidance panel urges health care providers caring for adults to encourage hepatitis C screening and treatment (if positive) because DAA therapy is safe and cures HCV infection in most people.…”

“…Importantly, this recommendation includes persons with ongoing substance use (alcohol or drugs). Several studies demonstrate that treatment‐committed individuals in this disproportionately affected population achieve sustained virologic response (SVR) rates with DAA therapy comparable to those without known, current substance use . The universal treatment recommendation represents a principal tenet of the HCV guidance along with newly recommended universal hepatitis C screening of adults.…”

Cross-country migration linked to people who inject drugs challenges the long-term impact of national HCV elimination programmes

“…1 Long overdue, most national elimination programmes now also include access to care for people who inject drugs (PWID), 2 who are at the core of ongoing HCV transmission. 3 Macías et al 4 have recently shown in this Journal that high viral cure rates can be achieved in this group, hereby providing evidence that targeting PWID in treatment programmes is worthwhile. However, the extent to which such national efforts can reduce the HCV burden not only depends on the uptake into care and treatment success rates, it is also determined by the relative importance of within-country transmission and virus importation from elsewhere.…”

“…12 As more recent subtype 1a and 3a infections are associated with illicit (injecting) drug use (e.g. 3), targeting this group that drives onwards spread, and for which Macías et al 4 have demonstrated that treatment can be highly effective, is most desirable in many countries. However, across Europe, most countries have yet to embrace the universal treatment paradigm, and even more are yet to develop and implement a national strategy towards the elimination of HCV.…”

Civil Society Monitoring of Hepatitis C Response Related to the WHO 2030 Elimination Goals in 35 European Countries

“…Several studies have shown that treatment with direct acting antivirals (DAAs) in PWID is as effective as in the general population. Evidence already exists that aside of harm reduction programs, unrestricted and immediately accessible DAAs can lower the HCV prevalence among PWID (7,8). However, in the last decade, due to ageing of HCV chronically infected PWID with untreated HCV infection and late presentation, the mortality from HCV infection has increased particularly in this marginalised group, and deaths from liver disease are now as common as deaths from overdose in PWID over 50 years of age (9,10).…”