Theme: Epidemiology & Public Health Research Year: 2022
Background:
Chronic infection with the hepatitis C virus (HCV) has a detrimental impact on health-related quality
of life (QoL). The introduction of highly-effective interferon-free direct-acting antiviral (DAA) therapy
has spurred the scale-up of treatment among people who inject drugs (PWID) in a number countries.
Data are lacking regarding the impact of treatment success on QoL for this population in this new
era.
Methods:
We implemented two study designs to assess the association between QoL (measured using the EQ5D-5L instrument) and HCV treatment outcome among PWID in Scotland . First, using data from two
sweeps of the Needle Exchange Surveillance Initiative (2017/18 and 2019/20), a national, crosssectional, voluntary, anonymous survey, we examined the association between QoL and
achievement of sustained virologic response (SVR) using multivariable linear regression analysis. In
the second, longitudinal, study involving 83 PWID who underwent successful antiviral therapy, we
compared QoL between the time-points (a) treatment start (baseline), (b) time of SVR test, and (c)
12 months following treatment start, using linear mixed-effects regression analysis.
Results:
Among the cross-sectional study population (n=4009), 41% were ever chronically HCV infected, of
whom 49% (n=799) had ever undergone antiviral therapy. Adjusting for demographic, lifestyle, and
living situation covariates, there was neither evidence for a QoL improvement associated with viral
clearance among those who had ever been treated for HCV (B = 0.03, P=0.32). In contrast, among
the longitudinal study participants QoL improved (compared with the baseline QoL measurement) at
the time of SVR test (B = 0.19, P<0.01), but QoL at 12 months following treatment start was not
statistically distinguishable from baseline QoL (B = 0.03, P=0.52).
Conclusion:
Evidence from our large population-based survey indicates that successful antiviral treatment does
not lead to a durable improvement in QoL among DAA-treated HCV-infected PWID, consistent with
data from the longitudinal study demonstrating a transient positive impact on QoL around the time
of SVR achievement.
Disclosure of Interest Statement:
SJH has received honoraria from Gilead, unrelated to submitted work. No conflicts of interest
declared.