DAA 2nd Generation Treatment Outcome in Substance Users

Author: Rosalie Larribau, Sami Krakria, Erika Castro and Health Care Providers

Theme: Clinical Research Year: 2016


Rosalie Larribau1, Sami Krakria1, Erika Castro1 and Health Care Providers1

1Policlinique d’addictologie Centre St-Martin. Service de Psychiatrie Communautaire, Centre Hospitalier Universitaire Vaudois (CHUV). Lausanne, Switzerland.

Background: Since 2015 2nd generation DAA treatments are prescribed in Switzerland in accordance to national expert guidelines and Swiss health insurance reimbursement rules (SHIRR). This report discusses hepatitis C screening, DAA treatment access and outcomes in substance users followed in an outpatient addiction medicine service from the University hospital of Lausanne.

Patients and Methods: Overall 447 substance users were followed by January 2015. The average age was 39 years (range: 20-65), 75% were men, 92% were on opiate substitution treatment, 69% received a social security or disability pension and 17% were homeless. Prevalence of positive anti-HCV antibodies was 50% (n=223) with 28% (n=125) presenting documented RNA viremia (>15 UI/mL). Liver fibrosis score was assessed in 90 patients with onsite fibroscan: F3-F4 in 19%, F2 in 15% and F1-0 in 66% of patients. Genotype (GT) distribution was GT1: 58%, GT3: 31%. and GT2-6: 11%.

Results: Based on SHIRR 9/24 patients achieving readiness for treatment started a DAA regimen between March-2015 and April-2016. Ribavirine (RBV) was combined in 5/9 DAA regimens. Average age was 48 years (range: 40-64); 6/9 were naïve to treatment; 3/9 were previous Peg-interferon/RBV experienced patients. HIV co-infection was present in 3/9 and liver cirrhosis in 7/9 patients. HCV GT1 and 3 were equally represented. SVR was confirmed in 4 patients achieving EOT and RVR was present in 2/4 of remaining patients in treatment follow-up. Serious adverse events were documented as one psychiatric hospitalization for worsening of pre-existing condition and one treatment interruption due to skin rash onset on day 1. Drug-drug interactions involved basically antiretroviral drugs and antidepressant treatments.

Discussion and conclusion: Only a third of patients achieving readiness for DAA treatment was equally accounting for SHIRR (≥F2 liver fibrosis or documented extra-hepatic disease). SVR was present in all 4 patients achieving EOT. Two serious AE were recorded.

Disclosure of Interest Statement: Echosens fibroscan 402 was co-sponsored by the local pharmaceutical industry (Gilead, Janssen-Cilag AG and MSD).

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