Abstract
Background: People who inject drugs (PWID) are the largest group at risk for HCV infection. Despite the direct acting antivirals (DAA) advancements, HCV elimination has been hindered by real-life difficulties in PWID. Aims: This study aimed to assess the impact of a multidisciplinary intervention strategy where HCV screening, treatment and follow-up were performed at the same location on efficacy and safety of DAA-therapy in real-life PWID population. Methods: All HCV-infected PWID referred to five specialized outpatient centers for drug addicts (SerDs) in Northern Italy were prospectively enrolled from May 2015 to December 2019. Hepatologists and SerDs healthcare workers collaborated together in the management of PWID inside the SerDs. Sustained virologic response (SVR), safety of treatment, proportion of patients lost to follow-up and reinfection rate were evaluated. Results: A total of 358 PWID started antiviral treatment. About 50% of patients had advanced fibrosis/cirrhosis, 69% received opioid substitution treatment, and 20.7% self-reported recent injecting use. SVR was achieved in 338 (94.4%) patients. Two patients died during treatment; one prematurely discontinued, resulting in a non-responder; twelve were lost during treatment/follow-up; and five relapsed. No serious adverse events were reported. SVR was lower in recent PWID than in former ones (89.2% vs. 95.8%; p = 0.028). Seven reinfections were detected, equating to an incidence of 1.25/100 person-years. Reinfection was associated with recent drug use (OR 11.07, 95%CI 2.10–58.38; p = 0.005). Conclusion: Our embedded treatment model could be appropriate to increase the linkage to care of HCV-infected PWID. In this setting, DAA regimens are well tolerated and highly effective, achieving a lower rate of reinfection.
Highlights
It is well established that hepatitis C virus (HCV) is a major cause of liver related mortality and a well-recognized trigger for extrahepatic disease [1]
A total of 371 HCV-infected People who inject drugs (PWID) were evaluated for antiviral treatment, and 358 (96.5%) started interferon-free direct acting antivirals (DAA) combinations (Figure 2)
HCV treatment delivered to PWID within our multidisciplinary program of care leads to very high Sustained virologic response (SVR) rates and treatment adherence and a low rate of drop-out
Summary
It is well established that hepatitis C virus (HCV) is a major cause of liver related mortality and a well-recognized trigger for extrahepatic disease [1]. Manageable, safe, and effective widespread use of DAAs has permitted the treatment in a large part of the HCV population, including both individuals with and without cirrhosis [3]. With the availability of high-efficacy DAAs, these strategies are no longer intended as an improvement of therapeutic effectiveness but an expansion of public policies of screening and treatment (increasing HCV diagnoses from
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