High Efficacy Of Direct-Acting Antiviral HCV Treatment Among People With Recent Injecting Drug Use: A Real-Life Experience

Author: Ulstein K, Midgard H, Backe Ø, Foshaug T, Wüsthoff L, Dalgard O

Theme: Clinical Research Year: 2018

Background: Direct-acting antivirals (DAAs) have facilitated HCV treatment among people who inject drugs (PWID). The primary aim of this study was to evaluate the efficacy of DAA treatment in a population of recent PWID attending a low-threshold clinic. Approach: In 2013, a low-threshold clinic was established in downtown Oslo, staffed with two nurses and a general practitioner with infectious diseases specialist support. We included consecutive patients who had received ≥one dose of DAAs and had injected drugs within the last six months prior to treatment. The primary endpoint was sustained virological response (SVR), defined as undetectable HCV RNA ≥4 weeks after end of treatment. The secondary endpoint was treatment adherence, defined as ≥90% of prescribed doses taken assessed by self-report or provider observations. Results: Of 106 included patients (mean age 49 years, 76% male, 29% cirrhosis), 55% had genotype 1, 8% had genotype 2, and 40% had genotype 3 infection. Opioid substitution treatment was taken by 84/106 (79%), 83/106 (78%) injected drugs during treatment, and 58/106 (58%) had stable housing. Treatment was administered by one- to two week pillbox in 44/106 (42%), by direct-observed therapy in 30/106 (28%), or by a combination in 32/106 (30%). Among those due for SVR evaluation by May 2018, 70/87 (80%) had obtained SVR in intentto-treat analysis. Virological failure was observed in one individual, 8/87 (9%) completed therapy but were subsequently lost to follow up, and 3/87 (3%) discontinued treatment (side effects, n=1; unrelated to treatment, n=2). In observed analysis, excluding treatment discontinuations and loss to follow up, 70/71 (99%) achieved SVR. Adherence of >90% was reported in 79/87 (91%) participants. Conclusion: Efficacy and adherence to DAA treatment was high in a population of recent PWID. This study provides real-life data on the feasibility of DAA treatment among recent PWID. Disclosure of Interest Statement: See example below: Liver stiffness is measured by a mobile FibroScan device donated by Abbvie to our collaborating partner The Salvation Army. Olav Dalgard received research grants from MSD, Abbvie and Gilead and participated at advisory boards for Abbvie and MSD. The conference collaborators recognise the considerable contribution that industry partners make to professional and research activities. We also recognise the need for transparency of disclosure of potential conflicts of interest by acknowledging these relationships in publications and presentations.

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