Therapy of chronic hepatitis C in people who inject drugs: focus on adherence

Abstract

Background Intravenous drug use (IVDU) represents the major factor of HCV transmission, but the treatment uptake among people who inject drugs (PWID) remains low owing to a false presumption of low efficacy. The aim of our study was to assess treatment efficacy in PWID and factors determining adherence to therapy. Methods A total of 278 consecutive patients starting DAA (direct-acting antivirals) therapy were included, divided into two groups: individuals with a history of IVDU, PWID group (N = 101) and the control group (N = 177) without a history of IVDU. Results Sustained virological response 12 weeks after the end of therapy (SVR12) was achieved by 99/101 (98%) and 172/177 (98%) patients in the PWID and control group, respectively; in PWID group, two patients were lost to follow-up, and in the control group, four patients relapsed and one was lost to follow-up. PWID patients postponed appointments significantly more often, 29 (28.7%) in PWID versus 7 (4%) in the control group, p = 0.001. Thirteen of 101 (12.9%) and six of 177 (3.4%) patients in the PWID and in the control group, respectively, missed at least one visit (p < 0.01). However, postponing visits led to a lack of medication in only one PWID. In the PWID group, older age (p < 0.05; OR 1.07, 95% CI 1.00–1.20) and stable housing (p < 0.01; OR 9.70, 95% CI 2.10–56.20) were factors positively contributing to adherence. Contrarily, a stable job was a factor negatively influencing adherence (p < 0.05; OR 0.24, 95% CI 0.06–0.81). In the control group, none of the analyzed social and demographic factors had an impact on adherence to therapy. Conclusions In PWID, treatment efficacy was excellent and was comparable with SVR of the control group. Stable housing and older age contributed to a better adherence to therapy.

HCV Elimination in Central Europe with Particular Emphasis on Microelimination in Prisons

“…This is a country with a low HCV prevalence (0.5%), which is a little bit higher among adults with risk factors (0.8%). Most new cases of HCV are diagnosed among PWID (75%) and referred for treatment by harm reduction services and psychiatric hospitals [ 18 , 19 ]. The genotype distribution remains stable ( Figure 1 ), but in the group of patients without a history of intravenous use of drugs, G1b still dominates (62%).…”

Adherence in Hepatitis C Virus Treatment: What We Know

“…when compared with patients who did not have a history of intravenous (IV) drug misuse. [6] Despite the differences in visit frequency, both groups showed similar rates of SVR at 12 weeks.…”

“…[25] Nevertheless, it is also important to acknowledge that reports of lower adherence and SVR rate in PWID can be influenced by limitations, including delayed testing and loss to follow-up. [26,27] PWID may also have different clinical characteristics, including virus subtype, from persons who do not inject drugs, [6,25] which may complicate adherence comparisons between groups. Similarly, viral load may be lower in populations of PWID, which may translate into higher rates of SVR despite suboptimal adherence.…”

Hepatitis C virus micro‐elimination in people who inject drugs: Challenges and chance in Taiwan and worldwide

“…Although the SVR rates are high among PWID and do not differ from those among non-PWID, the uptake of HCV treatment among PWID remain low. 35,36 The HCV care cascade includes diagnosis, linkage-tocare, and treatment. PegIFN/RBV-related barriers can be resolved with DAA use; however, barriers persist in other steps of the care cascade in PWID.…”

“…Although the SVR rates are high among PWID and do not differ from those among non‐PWID, the uptake of HCV treatment among PWID remain low 35,36 . The HCV care cascade includes diagnosis, linkage‐to‐care, and treatment.…”