Directly Acting Antiviral-Based Treatment for HCV-Infected Persons Who Inject Drugs: A Multicenter Real-Life Study.

Vincenzo Messina,Angela Salzillo,Valerio Rosato,Mariantonietta Pisaturo,Ernesto Claar,Riccardo Nevola,Fabio Curcio,Antonio Russo,Lorenzo Onorato,Vincenzo Iovinella,Nicola Coppola,Giovanni Di Caprio,Filomena Simeone

doi:10.3390/life11010017

Abstract

Background: We aimed to evaluate the factors associated with a virological response in a cohort of Hepatitis C virus (HCV)-infected people who inject drugs (PWID) treated with direct acting antivirals (DAAs). Methods: We conducted a multicenter retrospective cohort study enrolling HCV-infected PWID treated with DAAs. The primary outcome evaluated was the sustained virological response (SVR12) rate. Results: Five hundred and twenty HCV-infected PWID treated with all-oral DAA-based regimens were enrolled; a total of 168 (32.3%) patients presented genotype 1a, 109 (21.0%) genotype 1b, and 174 (33.5%) genotype 3; a total 152 of the 520 subjects (29.2%) were cirrhotics; a total 118 (22.7%) and 373 (71.7%) were treated with DAA regimens of second and third generation, respectively; a total 169 (33.6%) patients were receiving an opioid agonist at the start of antiviral therapy. Only 11 subjects (2.1%) did not show an SVR12. A significant correlation was found between treatment with opioid substitution therapy (p < 0.001), Human Immunodeficiency Virus (HIV) coinfection (p = 0.002), and treatment with first- or second-generation regimens (p = 0.0015) and HCV failure. Upon multivariate analysis, treatment with a first- or second-generation DAA was the only factor independently associated with failure (OR 10.4, 95% CI: 1.43 to 76.1, p = 0.02). Conclusions: Treatment with DAAs led to a high SVR12 rate (97.9%) in a large cohort of HCV-infected PWID. The only predictor of viral failure found in our analysis was treatment with first- and second-generation DAA.

Highlights

Patients treated with sofosbuvir plus ribavirin and those who refused to provide informed consent to participate in the study were excluded from the analysis
We evaluated the SVR12 rate to direct acting antivirals (DAAs)-based treatment in a large cohort of Hepatitis C virus (HCV)-infected people who inject drugs (PWID) and analyzed the factors associated with virological failure
Both European [18] and US [19] guidelines recommend the implementation of screening and linkage to care programs, as well as harm-reduction interventions in order to limit the spread of infection among this population and to achieve the goals for HCV elimination proposed by the World Health Organization (WHO) [20]

Summary

Introduction

Only a few clinical trials have addressed the efficacy and tolerability of DAAs in this special population [8,9,10], subanalyses of experimental studies and data from real-world experience in subjects with recent injection drug use or taking opioid substitution therapy have reported compliance rates and treatment outcomes that were comparable to those of the general population [11,12]. We aimed to evaluate the factors associated with a virological response in a cohort of Hepatitis C virus (HCV)-infected people who inject drugs (PWID) treated with direct acting antivirals (DAAs). Conclusions: Treatment with DAAs led to a high SVR12 rate (97.9%) in a large cohort of HCV-infected PWID. The only predictor of viral failure found in our analysis was treatment with first- and second-generation

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Discussion

Conclusion