Abstract
AimDespite effective treatment for recent hepatitis C (HCV) infection, side-effects and adherence concerns limit its use among people who inject drugs (PWID). This study evaluated health-related quality of life (HRQoL) and social functioning following infection and during recent HCV treatment.MethodsThe Australian Trial of Acute Hepatitis C studied the natural history and treatment of recent HCV infection. HRQoL (SF-12v2) and social functioning (Opiate Treatment Index score) were measured over 48 weeks and their impact on treatment uptake, adherence and virological response were assessed.ResultsOf 163 participants, 111 received treatment (HCV n = 74, SVR 55%; HCV/HIV n = 37, SVR 74%). 116 (71%) were male, 124 (76%) ever injected drugs, with 55 (36%) injecting recently and 28/55 (51%) reported needle/syringe sharing. At baseline, median physical and mental HRQoL was 54 units (IQR 46–58) and 46 (35–54) (reference median: 50), respectively, and median social functioning score was 11 units (7–17). Higher social function (<10 vs ≥15) predicted increased treatment uptake (AOR 3.43, 95%CI 1.01–11.6, p = 0.048) and higher SVR (AOR 5.11, 95%CI 1.30–20.15, p = 0.020). After adjustment, treated participants had lower physical (-4.90 units, 95%CI -6.33 to -3.48, p<0.001) and mental HRQoL (-3.7 units, 95%CI -5.55 to -1.86, p<0.001) at on-treatment visits, but HRQoL returned to baseline levels during follow-up.ConclusionsSocial functioning can predict recent HCV treatment uptake and SVR. Efforts to maximise social stability may improve treatment response. Pegylated-interferon treatment is associated with reduced HRQoL on-treatment in an already vulnerable population of PWID that would be better served by interferon-free regimens particularly in treated target at PWID to prevent transmission.Trial RegistrationClinicalTrials.gov NCT00192569
Highlights
Treatment of recently acquired hepatitis C virus (HCV) infection using pegylated-interferon (PEG-IFN) is effective and results in a sustained cure for most patients [1,2,3,4,5,6]
Treatment uptake and sustained virological response (SVR) are higher among those with better social functioning suggesting that supports to improve social marginalisation when embarking on HCV treatment may be beneficial
Optimising social stability may play an important role in managing acute HCV irrespective of the introduction of DAA therapies
Summary
Treatment of recently acquired hepatitis C virus (HCV) infection using pegylated-interferon (PEG-IFN) is effective and results in a sustained cure for most patients [1,2,3,4,5,6]. While interferon (IFN)-free therapies promise better and simpler treatment, access remains restricted largely due to cost and licensing limitations. Large scale treatment of recent HCV infection among people who inject drugs (PWID) could have important prevention benefits [11]. Chronic HCV infection is known to adversely influence health-related quality of life (HRQoL) [12,13,14,15,16,17,18]. HRQoL following recent HCV infection and during early treatment remains poorly understood. Successful early treatment has the potential to avoid future declines in health status as well as prevent transmission
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