Theme: Clinical Research Year: 2017
Background: In Canada, despite the universal health care system, access to HCV treatment remains limited for drug users (DU). Many physicians prefer to ensure abstinence before initiating treatment. However, from a public health point of view is when DU consumes drugs that are more at risk of transmission. The aim of this study was to assess our ability to cure HCV infection in DU regardless of their consumption.
Methods: All HCV-treated patients followed at Clinique Medicale du Quartier Latin(CMQL) were included in this retrospective study. Information on socio-demographics, medical history was collected from the electronic medical chart. At CMQL HCV-patients are followed by a multidisciplinary team (nurse, family doctor, hepatologist, social worker, community pharmacist)and have access to a low threshold opioid substitution therapy(OST) if they need so. Sustained virological response rate at 12weeks after end of therapy (SVR12) was calculated by Intent-to-treat analysis(ITT). Determinants of SVR were analysed by multiple logistical regression using SPSS24.
Results: 104 HCV patients treated with INF-free-DAA were included in this study.79% were men, with a mean age of 53y (IQR:48y-59y). 46% were HIV-coinfected, 23% active-IDU, 14% on OST, 5% without housing, 46% with ROH-problem, 31%cirrhotic, 77% infected with genotype1and 70% naïve at treatment initiation. 85% achieved SVR12 while 2% discontinued treatment. Even if SVR seems higher in non-IDU, results were not significant (90% vs. 84% previous-IDU and 78% active-IDU;p=0.471). 100% of patients on OST achieved SVR. In multivariate analyses, after controlling for gender, age, drug and alcohol use, housing, depression, diabetes, HIV-coinfection, treatment history and genotype, cirrhosis was the only determinant who impacted SVR (aOR=0.13;95%CI=0.04-0.46;p=0.002).
Conclusion: At CMQL, the SVR rate remained high and did not differ by IDU status. The «difficult-to-treat» DU are manageable if we offer them adequate support. OST is one of the best opportunities for curing active-drug users for their HCV.