Combining treatment for chronic hepatitis C with opioid agonist therapy is an effective microelimination strategy for people who inject drugs with high risk of non-adherence to direct-acting antiviral therapy
Background & aims: Despite effective direct-acting antivirals (DAAs), hepatitis C virus (HCV) prevalence is high among people who inject drugs (PWIDs) and non-adherence to therapy remains a major obstacle towards HCV elimination in this subpopulation. To overcome this issue, we have combined...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-03-01
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| Series: | Journal of Virus Eradication |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2055664023000055 |
| _version_ | 1797842275544334336 |
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| author | M. Schwarz C. Schwarz A. Schütz C. Schwanke E. Krabb R. Schubert S.-T. Liebich D. Bauer L. Burghart L. Brinkmann E. Gutic T. Reiberger H. Haltmayer M. Gschwantler |
| author_facet | M. Schwarz C. Schwarz A. Schütz C. Schwanke E. Krabb R. Schubert S.-T. Liebich D. Bauer L. Burghart L. Brinkmann E. Gutic T. Reiberger H. Haltmayer M. Gschwantler |
| author_sort | M. Schwarz |
| collection | DOAJ |
| description | Background & aims: Despite effective direct-acting antivirals (DAAs), hepatitis C virus (HCV) prevalence is high among people who inject drugs (PWIDs) and non-adherence to therapy remains a major obstacle towards HCV elimination in this subpopulation. To overcome this issue, we have combined ongoing opioid agonist therapy (OAT) with DAAs in a directly-observed therapy (DOT) setting. Method: From September 2014 until January 2021 PWIDs at high risk of non-adherence to DAA therapy, who were also on OAT, were included into this microelimination project. Individuals received their OAT and DAAs under supervision of healthcare workers as DOT in a pharmacy or low-threshold facility. Results: In total, 504 HCV RNA-positive PWIDs on OAT (387 men, 76.8%; median age: 38 years [IQR 33–45], HIV: 4.6%; hepatitis B: 1.4%) were included into this study. Two thirds reported ongoing intravenous drug use (IDU) and half of them had no permanent housing. Only 41 (8.1%) were lost to follow-up and two (0.4%) died of reasons unrelated to DAA toxicity. Overall, 90.7% of PWIDs achieved sustained virological response 12 weeks after treatment (SVR12) (95% CI: 88.1–93.2%). By excluding those lost to follow-up and hose who had died of causes unrelated to DAAs, the SVR12 rate was 99.1% (95% CI: 98.3–100.0%; modified intention-to-treat analysis). Four PWIDs (0.9%) experienced treatment failure. Over a median follow-up of 24 weeks (IQR 12–39), 27 reinfections (5.9%) were observed in individuals with the highest IDU rates (81.2%). Importantly, even though some were lost to follow-up, all completed their DAA treatment. By using DOT, adherence to DAAs was excellent with only a total of 86 missed doses (0.3% of 25,224 doses). Conclusions: In this difficult-to-treat population of PWIDs with high rates of IDU , coupling DAA treatment to OAT in a DOT setting resulted in high SVR12 rates equivalent to conventional treatment settings in non-PWID populations. |
| first_indexed | 2024-04-09T16:45:17Z |
| format | Article |
| id | doaj.art-fbaf3371873741dea6c3a1ebf21e4342 |
| institution | Directory Open Access Journal |
| issn | 2055-6640 |
| language | English |
| last_indexed | 2024-04-09T16:45:17Z |
| publishDate | 2023-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Virus Eradication |
| spelling | doaj.art-fbaf3371873741dea6c3a1ebf21e43422023-04-23T06:06:03ZengElsevierJournal of Virus Eradication2055-66402023-03-0191100319Combining treatment for chronic hepatitis C with opioid agonist therapy is an effective microelimination strategy for people who inject drugs with high risk of non-adherence to direct-acting antiviral therapyM. Schwarz0C. Schwarz1A. Schütz2C. Schwanke3E. Krabb4R. Schubert5S.-T. Liebich6D. Bauer7L. Burghart8L. Brinkmann9E. Gutic10T. Reiberger11H. Haltmayer12M. Gschwantler13Klinik Ottakring, Department of Internal Medicine IV, Vienna, Austria; Medical University of Vienna, Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Vienna, Austria; Vienna HIV & Liver Study Group, Vienna, AustriaKlinik Ottakring, Department of Internal Medicine IV, Vienna, Austria; Medical University of Vienna, Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Vienna, Austria; Vienna HIV & Liver Study Group, Vienna, AustriaSuchthilfe Wien gGmbH, Ambulatorium Suchthilfe Wien, Vienna, AustriaSuchthilfe Wien gGmbH, Ambulatorium Suchthilfe Wien, Vienna, AustriaSuchthilfe Wien gGmbH, Ambulatorium Suchthilfe Wien, Vienna, AustriaSuchthilfe Wien gGmbH, Ambulatorium Suchthilfe Wien, Vienna, AustriaSuchthilfe Wien gGmbH, Ambulatorium Suchthilfe Wien, Vienna, AustriaKlinik Ottakring, Department of Internal Medicine IV, Vienna, Austria; Medical University of Vienna, Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Vienna, Austria; Vienna HIV & Liver Study Group, Vienna, AustriaKlinik Ottakring, Department of Internal Medicine IV, Vienna, Austria; Medical University of Vienna, Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Vienna, Austria; Vienna HIV & Liver Study Group, Vienna, AustriaKlinik Ottakring, Department of Internal Medicine IV, Vienna, Austria; Medical University of Vienna, Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Vienna, Austria; Vienna HIV & Liver Study Group, Vienna, AustriaKlinik Ottakring, Department of Internal Medicine IV, Vienna, AustriaMedical University of Vienna, Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Vienna, Austria; Vienna HIV & Liver Study Group, Vienna, AustriaSuchthilfe Wien gGmbH, Ambulatorium Suchthilfe Wien, Vienna, AustriaKlinik Ottakring, Department of Internal Medicine IV, Vienna, Austria; Sigmund Freud University, Vienna, Austria; Corresponding author. Klinik Ottakring, Department of Internal Medicine IV, Vienna, Austria.Background & aims: Despite effective direct-acting antivirals (DAAs), hepatitis C virus (HCV) prevalence is high among people who inject drugs (PWIDs) and non-adherence to therapy remains a major obstacle towards HCV elimination in this subpopulation. To overcome this issue, we have combined ongoing opioid agonist therapy (OAT) with DAAs in a directly-observed therapy (DOT) setting. Method: From September 2014 until January 2021 PWIDs at high risk of non-adherence to DAA therapy, who were also on OAT, were included into this microelimination project. Individuals received their OAT and DAAs under supervision of healthcare workers as DOT in a pharmacy or low-threshold facility. Results: In total, 504 HCV RNA-positive PWIDs on OAT (387 men, 76.8%; median age: 38 years [IQR 33–45], HIV: 4.6%; hepatitis B: 1.4%) were included into this study. Two thirds reported ongoing intravenous drug use (IDU) and half of them had no permanent housing. Only 41 (8.1%) were lost to follow-up and two (0.4%) died of reasons unrelated to DAA toxicity. Overall, 90.7% of PWIDs achieved sustained virological response 12 weeks after treatment (SVR12) (95% CI: 88.1–93.2%). By excluding those lost to follow-up and hose who had died of causes unrelated to DAAs, the SVR12 rate was 99.1% (95% CI: 98.3–100.0%; modified intention-to-treat analysis). Four PWIDs (0.9%) experienced treatment failure. Over a median follow-up of 24 weeks (IQR 12–39), 27 reinfections (5.9%) were observed in individuals with the highest IDU rates (81.2%). Importantly, even though some were lost to follow-up, all completed their DAA treatment. By using DOT, adherence to DAAs was excellent with only a total of 86 missed doses (0.3% of 25,224 doses). Conclusions: In this difficult-to-treat population of PWIDs with high rates of IDU , coupling DAA treatment to OAT in a DOT setting resulted in high SVR12 rates equivalent to conventional treatment settings in non-PWID populations.http://www.sciencedirect.com/science/article/pii/S2055664023000055PWIDHCVOpioidDrug useHepatitisDirectly observed therapy |
| spellingShingle | M. Schwarz C. Schwarz A. Schütz C. Schwanke E. Krabb R. Schubert S.-T. Liebich D. Bauer L. Burghart L. Brinkmann E. Gutic T. Reiberger H. Haltmayer M. Gschwantler Combining treatment for chronic hepatitis C with opioid agonist therapy is an effective microelimination strategy for people who inject drugs with high risk of non-adherence to direct-acting antiviral therapy Journal of Virus Eradication PWID HCV Opioid Drug use Hepatitis Directly observed therapy |
| title | Combining treatment for chronic hepatitis C with opioid agonist therapy is an effective microelimination strategy for people who inject drugs with high risk of non-adherence to direct-acting antiviral therapy |
| title_full | Combining treatment for chronic hepatitis C with opioid agonist therapy is an effective microelimination strategy for people who inject drugs with high risk of non-adherence to direct-acting antiviral therapy |
| title_fullStr | Combining treatment for chronic hepatitis C with opioid agonist therapy is an effective microelimination strategy for people who inject drugs with high risk of non-adherence to direct-acting antiviral therapy |
| title_full_unstemmed | Combining treatment for chronic hepatitis C with opioid agonist therapy is an effective microelimination strategy for people who inject drugs with high risk of non-adherence to direct-acting antiviral therapy |
| title_short | Combining treatment for chronic hepatitis C with opioid agonist therapy is an effective microelimination strategy for people who inject drugs with high risk of non-adherence to direct-acting antiviral therapy |
| title_sort | combining treatment for chronic hepatitis c with opioid agonist therapy is an effective microelimination strategy for people who inject drugs with high risk of non adherence to direct acting antiviral therapy |
| topic | PWID HCV Opioid Drug use Hepatitis Directly observed therapy |
| url | http://www.sciencedirect.com/science/article/pii/S2055664023000055 |
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