Treatment Of HCV Infection Research Articles

SOFOSBUVIR: TREATMENT OF CHRONIC HEPATITIS C AND THE MAIN TRENDS IN PATENT PROTECTION

The purpose of the study was to analyze and systematize the literature data on the benefit/risk ratio of sofosbuvir administration in the treatment of patients with chronic hepatitis C and the main trends in its patent protection. Studies were conducted using databases on the Internet: Ukrainian patent office, the European patent office, the US patent office, the Food and drug administration, European Medicines Agency (EMEA), State enterprise “The State Expert Center” of the Ministry of Health of Ukraine. It has used retrospective, logical, systematic and analytical methods. Data from clinical studies abroad and meta-analyses indicate that sofosbuvir is one of the most promising drugs for the treatment of chronic HCV infection. Its indisputable advantages are that this drug can be used with different genotypes of the virus, decompensated liver function, it is well tolerated. Sofosbuvir has an improved safety profile and a low probability of viral resistance. The high cost of sofosbuvir is due to the powerful patent protection. As mechanisms for working with patent barriers, it is recommended to use the flexible mechanisms of the TRIPS Agreement: the grant of compulsory licenses, the implementation of parallel imports, the tightening of the criteria for patentability (prohibition of patenting new forms that do not improve therapeutic efficacy).

SVR12 rates higher than 99% after sofosbuvir/velpatasvir combination in HCV infected patients with F0-F1 fibrosis stage: A real world experience.

Background and objectivesThe pangenotypic single tablet regimen of NS5B inhibitor sofobuvir (SOF) and NS5A inhibitor velpatasvir (VEL) is advised for 12 weeks in HCV-infected patients including those with compensated cirrhosis. Addition of ribavirin (RBV) may be considered in genotype 3 (GT3) with compensated and is recommended in decompensated cirrhosis. Real-life results with SOF/VEL are limited. To evaluate efficacy and safety in a large real-world-cohort including patients with different GTs and various fibrosis stages.DesignIn total, 1429 patients were treated with SOF/VEL 400/100 mg for 12 weeks in the Puglia registry between June 2017 and May 2018. 1319 (92.3%) reached week 12 post-treatment (SVR12) at the moment. Only 41 received RBV. Diagnosis of cirrhosis was based on transient elastography and/or APRI or FIB-4 scores. Sensitivity analysis in the population including all patients except non virological failure was conducted. Primary efficacy endpoint was the percentage of patients with SVR12.ResultsPatients’ mean age was 63.8 years, 42.3% had GT1. The majority were naïve and 735 (55.5%) F0/F2. Of the remaining 587, 282 had cirrhosis. SVR12 was 98.5%, 98.0% in GT1, 99.4% in GT2, 97.1% in GT3, 100% in GT4. Overall, SVR12 by sensitivity analysis was 99.4%; 99.7% among F0-F1. Among 218 PWID, SVR12 was 94.5%. Discontinuation rates were 3.7% among PWID and 0.7% among non-PWID (p = 0.004).ConclusionsSOF/VEL treatment of chronic HCV infection reaches very high cure rates in a variety of patients; including those with F0/F1 and PWID.

Ceruloplasmin as a Predictor for Responsiveness to Direct Antiviral Drugs in Treatment of Chronic HCV Infection

Ceruloplasmin as a Predictor for Responsiveness to Direct Antiviral Drugs in Treatment of Chronic HCV Infection

Piloting Hepatitis C Virus Treatment in People Who Inject Drugs (PWID) in Bangladesh

Background: Treatment of hepatitis C virus infection in people who inject drugs (PWID) is complicated by their lifestyle, lack of social and family support, adherence to treatment, and reinfections. This study assessed the feasibility of treating HCV infection with direct-acting antiviral (DAA) among PWID who were receiving services from one Drop-in-Centre (DIC) in Dhaka, Bangladesh. Methods: In this prospective study, 200 PWID were enrolled between May to July 2017. Blood was collected to conduct relevant laboratory tests. Face to face interviews were conducted to determine HCV related risk behaviours. All eligible PWID who were HCV RNA positive were provided daily daclatasvir (60 mg) and sofosbuvir (400 mg) for 12 weeks after which adherence level, SVR, and reinfections were assessed. Findings: Antibodies to HCV were positive for 79 (39·5%) and HCV RNA for 68 (34%). The risk of HCV infection was significantly higher among those who had been injecting drugs for more than seven years (AOR: 2·1; 95% CI: 1·0-4·2; p=0·05). Of 55 eligible PWID started on treatment, 48 were available for SVR assessment (Intention-to-treat SVR 87%). All achieved SVR except one reinfection (4·2 cases per 100 person¬-years). 75% (41 of 55) were at least 90% adherent to therapy. The new infection rate was 2·04 cases per 100 person-years (49 person years of follow-up). Interpretation: Our findings confirm that HCV treatment using sofosbuvir+daclatasvir for PWID enrolled in existing harm reduction programme in Bangladesh is feasible but requires additional interventions such as Opioid Substitution Therapy, intense follow-up, and counselling by study staffs. Funding Statement: World Health Organization. Declaration of Interests: All authors declare no competing interests. Ethics Approval Statement: International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) has approved this study (PR-16033) after receiving the approval from institutional Research Review Committee (RRC) and Ethical Review Committee (ERC). The participants provided the written consent prior to enrollment.

The benefits of a public pharmacist service in chronic hepattis C treatment: The real-life results of sofosbuvir-based therapy.

In Brazil, the sofosbuvir-based therapy was introduced in the public health system (SUS) in 2015 to treat Chronic Hepatitis C (CHC). This drug and other direct-acting antiviral agents (DAAs) represent a major advance in the HCV-infection treatment due to their high effectiveness and tolerability. However, the drug safety profile is limited by significant drug interactions and its use is restricted for their high cost. Pharmacists have the opportunity to improve patient care by monitoring the therapy, recommending strategies to guarantee treatment adherence, effectiveness and safety, preventing complications of the disease, and drug-related problems, thus reducing the cost for patients and payers. This study aimed to assess the results of the one of the first patient group treated with sofosbuvir in Brazil and their opinions about the benefits of clinical pharmacist services in the achievement of the cure for CHC and in the management of their therapy difficulties. This cohort study (November 2015-January 2017) enrolled 240 patients followed up by the clinical pharmacists at the University Pharmacy (UPh) of the Federal University of Santa Catarina, Brazil, during the CHC treatment. The therapeutic schemes used were sofosbuvir+daclatasvir or+simeprevir associated or not with ribavirin. At the end of the therapy, the patients provided qualitative feedback about the clinical pharmacist services. The study demonstrated high levels of treatment adherence (99.2% of completion rates) and effectiveness rates (Sustained Virological Response rates) (92.1%). Patients reported high levels of satisfaction with the care provided on account of the good rapport built with their pharmacist, the counseling and education on HCV-infection and on sofosbuvir-based therapy utilization, motivation for adherence, and convenient access to the pharmacist. The clinical pharmacist services provided by the UPh was beneficial to patients treated for CHC with the sofosbuvir-based therapy.

Unawareness of HCV serostatus among persons newly diagnosed with HIV

Treatment of chronic HCV infection with direct acting antivirals can achieve high rates of sustained viral response in persons with HIV. In the perspective of HCV elimination in this population, high rates of HCV detection will be needed. We evaluated the unawareness of HCV infection in 2927 persons newly diagnosed with HIV during 2004–2015 in Rome, Italy. Two-hundred-fifty persons (8.5%) were anti-HCV positive. The proportion of HCV-unaware individuals at the time of HIV diagnosis was 58.0% (145/250), without significant variations over time, 17.2% showed an advanced fibrosis stage. The absence of previous HIV testing was significantly associated with HCV unawareness.

A novel, potent, and orally bioavailable thiazole HCV NS5A inhibitor for the treatment of hepatitis C virus

A medicinal chemistry program based on the small-molecule HCV NS5A inhibitor daclatasvir has led to the discovery of dimeric phenylthiazole compound 8, a novel and potent HCV NS5A inhibitor. The subsequent SAR studies and optimization revealed that the cycloalkyl amide derivatives 27a-29a exhibited superior potency against GT1b with GT1b EC50 values at picomolar concentration. Interestingly, high diastereospecificity for HCV inhibition was observed in this class with the (1R,2S,1′R,2′S) diastereomer displaying the highest GT1b inhibitory activity. The best inhibitor 27a was found to be 3-fold more potent (GT1b EC50 = 0.003 nM) than daclatasvir (GT1b EC50 = 0.009 nM) against GT1b, and no detectable in vitro cytotoxicity was observed (CC50 > 50 μM). Pharmacokinetic studies demonstrated that compound 27a had an excellent pharmacokinetic profiles with a superior oral exposure and desired bioavailability after oral administration in both rats and dogs, and therefore it was selected as a developmental candidate for the treatment of HCV infection.

Extracellular vesicles derived from CHK2 mRNA as a possible predictive marker of HCC in HCV-infected patients

Background: HCV infection treatment has experienced a remarkable advancement with the introduction of DAAs. However, HCC recurrence or de novo development in DAA treated patients represents an emerging issue that merits investigation.

Comparison of Anti-HCV Activity of Multiple Punica granatum Extracts and Fractions in Virus-infected Human Hepatocytes.

Plants extracts and their bioactive constituents can provide an alternative approach for new treatment. Pakistani flora reveals a huge, largely untapped source of potential antiviral constituents. High-cost concerns of direct-acting anti-HCV drugs limit their employment specifically in developing countries like Pakistan. Therefore, discovery of inexpensive and nontoxic agents is needed for HCV treatment. In this study, we used plasmid constructs of pCR3.1/FLAGtag/HCV NS3/4A (genotype 1a & 3a) and Punica granatum extracts (PK AV 003) and semi-purified fractions (P1-P11) were evaluated for their anti-HCV activity. Acetone extract along with two fractions (P4 & P11) revealed a useful therapeutic index. The fractions P4 (IC50=28.5±0.02 µg/ml; IC25=16±0.02 µg/ml) and P11 (IC50=72±0.02 µg/ml; IC25=41±0.03 μg/ml) dramatically suppressed HCV replication as measured by quantitative PCR (qPCR) and HCV NS3 protein expression level in transient transfection model. Consistent with suppression in genome replication, inhibition of HCV infectious particles by PK AV 003 extract was also judged in an infectious model system. This data is the first description of Pakistani indigenous cultivated fruit-producing plant, Punica granatum, possessing anti-HCV activity. Further analyses are being performed for investigating the mechanistic studies and structural characterization of purified fractions of PK AV 003. Our findings suggest that PK AV 003 fruit extract might be useful as an add-on therapeutic candidate for treating HCV infection.

Sofosbuvir/velpatasvir/voxilaprevir in the Treatment of Chronic Hepatitis C Infection

The landscape of HCV treatment has been entirely transformed due to the development of direct-acting antivirals (DAAs), but there are limited data guiding salvage therapy in patients who previously failed an NS5A inhibitor-containing DAA regimen. We review the preclinical and clinical data for sofosbuvir/velpatasvir/voxilaprevir (SOF/VEL/VOX), an interferon-free, oral, once daily, pan-genotypic treatment for chronic HCV infection. This combination is a highly effective, well-tolerated and safe 12-week treatment regimen for patients with any genotype, including genotype-3 patients with baseline resistance-associated substitutions (RAS). Its most distinctive role is in patients who have previously failed treatment with advanced DAA regimens. Its efficacy is not significantly affected by RASs, and treatment-emergent RASs are uncommon.

Interferon-Free Regimen: Equally Effective in Treatment Naive and Experienced HCV Patients

Introduction and aim. Interferon-free regimen has been reported to be highly efficient in treatment of HCV infection, including patients with compensated cirrhosis. We compared the efficacy of Ombitasvir, Paritaprevir, Ritonavir, Dasabuvir and Ribavirin (OBT/PTV/r, with DSV and RBV) therapy in patients with chronic HCV genotype 1b infection and compensated cirrhosis with and without prior treatment experience with pegylated interferon and ribavirin (IFN/RBV).Material and methods. A prospective two-center study was conducted in Mures County Hospital and Brasov County Hospital, Romania in period November 2015-July 2016. Both treatment naïve and PegIFN/RBV experienced patients with chronic HCV genotype 1b infection received 12 weeks of OBT/PTV/r, with DSV and RBV. Sustained virologic response 12 weeks after the treatment and eventual discontinuation of therapy due to adverse events were assessed in order to estimate safety and efficiency of therapeutic regimen.Results. Fifty nine patients were included in study, 35 (59.3%) of them were previously treated with IFN/RBV. Forty four (74.5%) patients were previously diag-nosed with cirrhosis Child Pugh score 5, while 15 (25.4%) with Child Pugh score 6. All 59 patients achieved a SVR12 of 100% and one patient from treatment naïve cohort discontinued the therapy due to hyperbilirubinemia and encephalopathy. However viral load assessed at 12 weeks after discontinuation of therapy in this patient was undetectable.Conclusion An all-oral regimen of co-for-mulated OBT/PTV/r with DSV and RBV results in high rate of sustained virologic response at post-treatment week 12 among HCV GT1b infected patients associated with compensated cirrhosis, regardless of previous treatment experience with PegIFN/RBV.

TYPE 2 DIABETES MELLITUS IN PATIENTS WITH CHRONIC VIRAL HEPATITIS C AND B

Summary. A number of clinical and population-based studies have shown a link between the development of insulin resistance and type 2 diabetes mellitus and hepatitis C.Purpose of research:to study the frequency of type 2 diabetes mellitus and its course in patients with chronic viral hepatitis C and B during antiviral therapy.Material and methods:213 patients (164 with CVH C, 34 with CVH B and 15 with CVH B + C) were examined before and in the course of treatment. All patients received standard antiviral therapy. In patients with type 2 diabetes, the level of fastingglycemiawas determined daily in the first 8-12 weeks of treatment. The level of glycemia was determined at the laboratory at least once every 2 weeks. Glycated hemoglobin was determined every 3 months during treatment and another 6 months after completion of the antiviral therapy.Results: In the group of patients with CVH C, type 2 diabetes mellitus occurred 2 times more often (13.4%) than in groups with CVH B (6.1%) with a reliability of p <0.01. With HCV genotype 3 is 2.5 times more often than with genotype 1 (p <0.001). Among patients, type 2 diabetes is 2.5 times more often men than women (p <0.01).Upon reaching an early virological response in 77.3% of patients, the level of glycemia returned to normal. The correlation coefficient between the achievement of a full virological response (negative PCR results on HCV RNA) and the normalization of the level of glycemia was 0.75. Glycemia control was maintained for 6 months after the completion of the antiviral therapy in the background of a persistent virological response.Conclusions:The presence of diabetes is the basis for screening for HCV, regardless of other factors. 75-77% of type 2 diabetes mellitus in the cohort of patients with CVH C is possibly virus-associated. Treatment of HCV infection can lead to a cure for type 2 diabetes mellitus in this category of patients.

Treatment of chronic HCV infection in people co-infected with HIV in a Spanish tertiary hospital and in relation to real life

Treatment of chronic HCV infection in people co-infected with HIV in a Spanish tertiary hospital and in relation to real life

Use of liver enzymes as a surrogate marker for monitoring treatment of hepatitis C virus disease

Introduction: Hepatitis C virus infects 3% people globally, that causes significant morbidity and mortality. For diagnosis and monitoring of treatment of HCV infection; biochemical markers and HCV RNA are tested. Aim of the Study: We tried to find out whether there is an association of liver enzymes (AST, ALT) and anti HCV antibody with the HCV viral load in patient's serum. Material and Methods:238 consecutive patients with suspected or confirmed Hepatitis C viral disease were included in this study. All consecutive samples of patients for two years were tested for HCV RNA quantification using real time PCR (viral load). Serum aminotransferase (AST, ALT) and anti-HCV antibody levels were also recorded and compared with the viral load. Correlation coefficient was used to study association between different parameters. Results: Significant positive correlation was found between liver enzymes (AST, ALT) and HCV viral load. Conclusion: There is a significant correlation between liver enzymes and RNA viral load. Therefore, viral load may be substituted with test for liver enzymes during monitoring of treatment, at least partially, and this could result in substantial cost savings.

Safety and efficacy of DCV-based DAAs therapy for chronic HCV infection in China

Objective: To evaluate the efficacy and safety of DCV-based DAAs therapy for chronic HCV infected Chinese patients. Methods: An open-label, non-randomized, prospective study was designed. Fifty-two patients with chronic HCV infection were enrolled. Among them, there was one patient after liver transplantation, 2 patients after kidney transplantation, 3 patients with hepatocellular carcinoma, and 4 patients with HBV infection. Thirteen cases with chronic hepatitis C (one compensated cirrhosis) who were negative for resistance-related variants [NS5A RAS (-)] of gene 1b and NS5A were treated with daclatasvir (DCV) + asunaprevir (ASV) for 24 weeks. Twenty-five cases of CHC (six compensated cirrhosis) with GT 1b, 2a, 3a, 3b, 6a were treated with DCV + SOF ± RBV for 24 weeks. 8 cases with decompensated cirrhosis of gene 1b and NS5A RAS(-) were given DCV + SOF + RBV regimen for 12 weeks. Six cases with decompensated cirrhosis, of gene 2a, 1b, 2a, 3a, 3b, were given DCV + SOF + RBV regimen for 24 weeks. HCV RNA, blood routine test, liver and kidney function, and upper abdominal ultrasound/MRI were measured at baseline, 4 weeks of treatment, end of treatment, and 12 weeks of follow-up. The incidence of adverse events and laboratory abnormalities during treatment were recorded. A t-test was used to compare the measurement data between two groups, and analysis of variance was used to compare the measurement data between multiple groups. Results: Sixteen patients (100%) achieved SVR12 after treatment, with 0% recurrence rate. Rapid virological response (RVR) of the four treatment regimens were 76.92%, 54.17%, 87.50%, and 83.33%, respectively, and 32 patients achieved 100% virological response after the completion of treatment. The incidence of adverse events of chronic hepatitis C with cirrhosis and decompensated cirrhosis was 62.5% and 64.29%, respectively. The most common adverse event was fatigue in CHC (25.00%), and elevated indirect bilirubin in decompensated cirrhosis (42.86%). No serious adverse drug events, deaths or adverse reactions occurred. Conclusion: DCV-based DAAs regimen is promising option for the treatment of HCV genotypes, compensated cirrhosis, decompensated cirrhosis, hepatocellular carcinoma, and HCV infection after liver/kidney transplantation in china. Above all, it has high SVR12 with good tolerability and safety profile.

Treatment with direct-acting antivirals improves the clinical outcome in patients with HCV-related decompensated cirrhosis: results from an Italian real-life cohort (Liver Network Activity-LINA cohort).

Direct-acting antivirals (DAAs) are safe and effective for the treatment of HCV infection. However, data regarding their efficacy in patients with Child-Pugh B cirrhosis are scarce and their capability in improving liver function is debated. The aim of our study was to assess the clinical benefits of treatment with DAA in subjects with Child-Pugh B cirrhosis. We conducted a prospective multicentre study among patients with Child-Pugh B cirrhosis of an Italian real-life HCV cohort (LINA cohort) who received treatment with DAAs. Among 89 patients enrolled, the rate of sustained virologic response 12 was 95.5%. No discontinuation occurred, no patient died during treatment. Most patients had Genotype 1 (1b 61.8%, 1a 11.2%). Conversely, 22.5%, 1.1% and 3.4% of patients had Genotype 2, 3 and 4, respectively. At last observation, 61.8% of patients switched to a Class A cirrhosis, 33.7% remained in Class B and 4.5 worsened to Child C (p < 0.001). Liver parameters significantly improved from baseline to 12weeks after the end of treatment. Previous anti-HCV treatments and the presence of decompensated cirrhosis at 1month of treatment were significantly associated with a decompensated cirrhosis at the last observation. Treatment with DAA in patients with Child-Pugh B cirrhosis is safe and leads to a very high rate of viral clearance, a significant rate of re-compensation and an improvement in liver function. Further studies are needed to assess the impact of treatment on survival and quality of life in long-term follow-up.

Early sofosbuvir-ledipasvir treatment for acute HCV infection induced severe immune thrombocytopenia \u2013 a case report

BackgroundHepatitis C virus (HCV) infection is a recognised cause of secondary immune thrombocytopenia (ITP). While its incidence has been largely described during chronic HCV infection, only one case of ITP secondary to acute HCV infection has been reported at this time.Case presentationWe report herein the case of severe ITP secondary to an acute HCV genotype 1a reinfection in a human immunodeficiency virus (HIV)-negative man having sex with men who had been cured several years before of a previous acute genotype 4d HCV infection. After an unsuccessful standard therapy with two courses of intravenous immunoglobulin (at 1 g/kg daily for 2 days) associated with methylprednisolone 1 mg/kg daily, antiviral treatment with sofosbuvir-ledipasvir rapidly achieved virological response and normalised the platelet count.ConclusionsAs a direct effect of HCV on megakaryocytes could be the predominant cause of ITP during acute infection, early antiviral treatment may be beneficial in this case.

2223. Effect of Direct-Acting Antivirals in Hemodialysis Patients with HCV: Real-Life Data

BackgroundHepatitis C virus (HCV) infection is widespread in hemodialysis patients worldwide. Studies of the effectiveness of new generation DAAs in the treatment of HCV infection in hemodialysis patients are limited.We investigated the effectiveness of DAAs in hemodialysis patients with HCV infection.MethodsTwenty-three HCV-positive treatment naïve or experienced (IFN/pegIFN±RBV) hemodialysis patients were enrolled.Three patients were excluded for not attending follow-ups regularly, and the data for 20 patients were included. Patients’ demographic, virological, and genotypic characteristics, liver fibrosis status, DAAs started, and sustained virological responses at the 12th week (SVR12) were recorded. DAA regimens based on the treatments patients were using and potential drug interactions.Patients completing treatment were followed for 12 weeks for SVR.ResultsThe mean age of the patients was 57.8 (±10.5). Ninety percent were men; 55% were treatment-experienced and 45% were treatment naïve. Ninety percent were noncirrhotic and 10% had compensated cirrhosis. Of the treatment-experienced patients, 45.5% were nonresponder and 54.5% were relapsed (Table 1). Eighteen patients with Genotype 1b were treated with paritepravir-ritonavir-ombitasvir-dasabuvir(ProD) for 12 weeks, one patient with Genotype 4 received ProD+ribavirin for 12 weeks, and one patient with Genotype 2 received sofosbuvir+ribavirin for 24 weeks. HCVRNA was negative on the 4th week in 85% of patients, and was negative in all patients on the 12th week, apart from the patient receiving the sofosbuvir+ribavirinregimen. At the end of treatment, HCVRNA was negative in all patients, and the SVR12 rate was 100%. Patients’ treatment responses were independent of previous treatments, liver fibrosis status, and hemodialysis duration. No marked side effects or complications were observed, apart from sleeplessness in one patient (Table 1).ConclusionOur study data confirm that new generation DAAs in hemodialysis patients provide high SVR and are well tolerated, as in patients other than those with chronic kidney disease. Achieving cure in hemodialysis patients is important in terms of preventing cross-contamination and of global elimination of HCV. Disclosures All authors: No reported disclosures.

Effect of mono/dual antiretroviral therapy on suppression of HCV and HIV during treatment of HCV infection in HIV/HCV-coinfected patients

ObjectiveData of hepatitis C treatment with direct-acting antivirals (DAAs) in HIV infected patients are limited to a few number of antiretroviral therapies (ART). The aim of this study was to assess the effectiveness and safety of non-conventional ART as monotherapy or dual therapy (MDT) when combined with DAA. MethodsRetrospective review of HIV/HCV-coinfected patients treated with DAAs during one year in 3 centers. Sustained virologic response 12 weeks after therapy (SVR) and maintenance of HIV viral suppression were compared between patients receiving triple ART (TT) or MDT. ResultsOverall 485 patients were included (359 receiving TT and 126 MDT). HCV SVR was 93.4% (95%CI, 90.8% to 95.3%) in the intention-to-treat analysis without differences between groups: 92.8% on TT vs 95.2% on MDT (p=0.3). HCV virological failure was associated with lower CD4+cell count at baseline (for every 100-cell/μl increment: OR, 0.8; 95%CI, 0.7-0.9; p=0.01) and with liver stiffness (for every 10-unit increment: OR, 1.5; 95%CI 1.2-1.8; p<0.01). HIV-RNA during HCV treatment or 12 weeks after was detectable in 23 patients on TT (6.6%) and 9 (7.2%) patients on MDT (p=0.8). The median (IQR) change in CD4+cell count was not significantly different between the groups: 15 (–55 to 115) in TT vs –12 (–68 to 133) cells/μl in MDT (p=0.8). ConclusionDAAs obtain high rates of SVR among HIV/HCV-coinfected patients independently of whether TT or non-conventional ART is used. Suppression of HIV was maintained in both groups.

Perceptions and self-reported competency related to testing, management and treatment of hepatitis C virus infection among physicians prescribing opioid agonist treatment: The C-SCOPE study

BackgroundThis study evaluated competency related to HCV testing, management and treatment among physicians practicing in clinics offering opioid agonist treatment (OAT). MethodsC-SCOPE is a study consisting of a self-administered survey among physicians practicing at clinics providing OAT in Australia, Canada, Europe and USA between April-May 2017. A 7-point scale was used to measure < average competence (score >4 of 7) related to HCV testing, management and treatment. ResultsAmong 203 physicians (40% USA, 45% Europe, 14% Australia/Canada) 21% were addiction medicine specialists, 29% psychiatrists, and 70% were metro/urban [mean PWID managed, 51; years of experience, 11]. The majority perceived HCV testing (82%) and treatment (85%) among PWID as important. The minority reported < average competence with respect to regular screening (12%) and interpretation of HCV test results (14%), while greater proportions reported < average competence in advising patients about new HCV therapies (28%), knowledge of new treatments (37%), and treatment/management of HCV (40%). In adjusted analysis, factors independently associated with < average self-reported competency related to the ability to treat HCV and manage side effects included fewer years in medical practice, fewer numbers of patients treated for HCV infection in the past six months, not having obtained information on screening, diagnosing or treatment of HCV, not having attended any training on HCV in the past year, and not having read or consulted AASLD/IDSA, EASL or other guidelines for HCV. ConclusionPhysicians treating HCV infection among PWID attending OAT clinics recognized the importance of HCV testing and treatment. However, self-perceived competency related to HCV management and treatment was low, highlighting the importance of improved HCV education and training among physicians practicing in clinics offering OAT.