Feasibility and Efficacy of Sofosbuvir-Based Regimens for Treatment of Hepatitis C Infection in a Low Threshold Setting

Author: Ulstein K, Backe Ø, Dalgard O, Vennesland K, Wüsthoff L

Theme: Clinical Research Year: 2016


Ulstein K1, Backe Ø1, Dalgard O2, Vennesland K1, Wüsthoff L1

1 City of Oslo, Agency for Social and Welfare Services, 2 University of Oslo, Akershus University Hospital

Introduction: Approximately 50% of people who inject drugs (PWID) in Oslo have chronic Hepatitis C (HCV) infection. Treatment uptake remains low among PWID despite changes in national guidelines recommending treatment also in this group. We aim at assessing the feasibility of treating HCV infection in PWID with sofosbuvir (SOF)-based therapy.

Methods: A low-threshold HCV clinic was opened in 2013 in collaboration between The City of Oslo and Akershus University Hospital and is staffed with two nurses, a general practitioner and supported by a specialist in infectious diseases. Consecutive patients were included if they had received at least one dose of SOF and were scheduled to end treatment within August 2016. HCV RNA positive patients with significant fibrosis or cirrhosis assessed by transient elastography were eligible for treatment. Significant fibrosis was defined as liver stiffness measurement (LSM) ≥ 7 kPa and cirrhosis was defined as LSM ≥ 12.5 kPa.

Results: Presently 40 patients are included; 10 women and 30 men. 36 patients received opiate substitution therapy, 34 injected drugs and 5 reported excessive alcohol intake during treatment. Cirrhosis was present in 23/40 and of those 13 had LSM >25 kPa. Among 18 patients with genotype 1, the following regimens were given: SOF/ledipasvir (LDV) +/-ribavirin (RBV) (n=15), SOF + simeprevir (n=2) and SOF+RBV (n=1). Five patients with genotype 2 received SOF+RBV and 17 patients with genotype 3 received SOF/LDV+RBV (n=8), SOF+pegylated interferon (pegIFN)+RBV (n=4), SOF+daclatasvir (DCV) +/-RBV (n=4) and SOF/LDV+DCV (n=1). To date one patient has terminated treatment early. 8 patients have reported missing 1-5 doses. 30 patients have completed treatment of which 28 have achieved SVR4, SVR4 results for one is pending and 1 has relapsed. Remaining results will be reported.

Conclusion: Our results show that administration of SOF-based therapy is feasible in a customized street clinic.

Disclosure of Interest Statement: Liver stiffness is measured by a mobile Fibroscan apparatus that is shared with the Salvation Army’s Street Clinic. The apparatus is donated to the Salvation Army by Abbvie.

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