Theme: Clinical Research Year: 2019
Background: People who use/inject drugs (PWID) account for the largest proportion of incident and HCV
infection in Canada. Many of these individuals remain undiagnosed or untreated and may already have
advanced liver disease with a short-term risk of significant complications.
Methods: We conducted a retrospective chart review of all HCV-positive PWID who have received
direct-acting antiviral (DAA) therapy at our centre, focusing specifically on those who were diagnosed
with cirrhosis prior to treatment by transient elastography (FibroScan, or FS, >12.5 kPa). All patients
received multidisciplinary care addressing medical, social psychological, and addiction-related needs.
Results: A total of 71 cirrhotic patients were included in this analysis: mean age 58 (35-78) years, 20%
female, 20% HIV co-infected, 32% on OST, 6% homeless/unstably housed, and 39% with a psychiatric
comorbidity, mean FS score 23.5 kPa. Of those who reached the SVR timepoint, 61/66 (92%) have
achieved sustained virologic response (SVR12). Two individuals are lost to follow-up (LTFU), 3 are
engaged in treatment elsewhere, and 5 have completed treatment and are awaiting outcome
measurement. For mean post-treatment long-term follow-up of 1.27 (0.04-6.23) years, available FS were
17.5 kPa ± 12.0. Hepatocellular carcinoma (HCC) occurred in 3 individuals, with no fatalities to date.
There have been no cases of virologic failure documented in this cohort.
Conclusion: Our data demonstrate the continued need for prioritization of PWID in the treatment of
HCV, with a proportion of these individuals requiring urgent treatment in the setting of advanced liver
disease. Within our multidisciplinary program, high cure rates were achieved, and those developing HCC
were readily maintained in care to address this new condition.
Disclosure of Interest Statement: Astou Thiam has received travel grants from AbbVie.
Julie Holeksa has received travel grants from AbbVie.
Dr. David Truong has received honoraria from Merck and Co.
Dr. Brian Conway has received grants, honoraria, travel funding, advisory board positions with AbbVie,
Merck & Co, Gilead Sciences and ViiV.