Theme: Clinical Research Year: 2019
Background: Annually, around 1800 persons make 26 000 visits at the Stockholm Needle Exchange
Program (NEP). 43% inject mainly heroin and 43% amphetamine. Mean age is 39 years and mean
duration of injection drug use is 18 years. 21% are homeless. HCV prevalence is 55%. Although
injection risk behaviors are significantly reduced over time among participants, HCV incidence
remains high (22/100 person years).
Methods: Since January 1st 2018 participants at the Stockholm NEP are offered HCV treatment with
no reimbursement restrictions. Fibrosis stages F0-F3 are mainly treated with 8 weeks of
sofosbuvir/ledispavir or glecaprevir/pribentasvir. Patients are HCV RNA tested every 6 months post
Results: So far 97 participants (75% amphetamine users) have initiated HCV treatment. 70/76 (91%)
were HCV RNA negative at end of treatment (EOT), 5 participants dropped out 1-2 weeks after
treatment initiation and one after 6 weeks. Overall, 47/56 (84%) reached SVR 12 (6 drop-outs and 3
lost to follow-up). Thus, all participants who completed treatment (n=70) were HCV RNA negative at
EOT and all with a follow-up visit at SVR 12 (n=47) were HCV RNA negative. Four reinfections
occurred post-SVR, representing a reinfection rate of 15/100 PY. One reinfection was spontaneously
cleared, leaving a persistent reinfection rate of 11/100 PY. On a parallel level, there were 92 new
HCV infections in the non-treated cohort during 2018.
Discussion: Even though 8-10% of the HCV viremic patients were treated at the Stockholm NEP in
2018, the number of new HCV infections were on the same level. A high prevalence of HCV and
amphetamine users (not eligible for OST) constitutes a great challenge for HCV elimination. Further
treatment- and reinfection data is pending and will be presented at the conference.
Disclosure of interest: MK has been a speaker and participated in advisory boards for Abbvie, Gilead
and MSD/Merck and has received grants from Gilead.