Author: Vera T, Guzman M, Soloway I, Joseph G, Agyemang L, Schwartz J, Akiyama M, Litwin AH

Theme: Clinical Research Year: 2019

Background: Although HCV treatment with DAAs leads to high SVR rates in people who use drugs
(PWUD), a minority fail antiviral treatment. Leveraging a multidisciplinary team, we investigated
reasons why PWUD failed DAA treatment and optimal retreatment strategies.
Methods: Chart reviews were performed for HCV-infected PWUD enrolled within an opioid agonist
treatment program in the Bronx, NY who failed combination DAA regimens between January 2015 and
October 2018. A multidisciplinary team, consisting of primary care providers, counselors, case managers,
and specialists in addiction medicine, infectious diseases, and hepatology, reviewed each case using a
structured instrument outlining potential reasons for failure, as well as retreatment strategies and
Results: Among 350 PWUD treated with combination DAAs, 13 had confirmed treatment failures:
ledipasvir/sofosbuvir (n=7), elbasvir/grazoprevir (n=4), and daclatasvir/sofosbuvir (n=2). Patient
characteristics included age (mean=52.7 years), cirrhosis (n=4), unstable housing (n=7), mental
illness (n=6), recent drug use (n=11), and drug or alcohol use during treatment (n=8). Potential
reasons for treatment failure included poor adherence (n=7), inadequate liver staging (n=3), provider
nonadherence to AASLD treatment guidelines (e.g. treating patients with cirrhosis or black race with
ledipasvir/sofosbuvir for only 8 weeks; n=2), inadequate case management for PWUD with
comorbidities (n=3), and patient reluctance to initiate treatment (n=2). Nine patients were retreated
with either sofosbuvir/velpatasvir/voxilaprevir (n=8) or glecaprevir/pibrentasvir (n=1), and the other 4
were lost to follow-up (n=2), ineligible for treatment (n=1), or declined (n=1). Overall, 6 achieved an end
of treatment response including 4 with a sustained virological response. One patient died from diabetes
and one was lost to follow-up. Successful patient-centered shared decision-making retreatment
strategies included not requiring DOT with prior poor adherence (n=2); collaboration with outside
providers (n=1); and flexible DOT (n=2). Two successful retreatment cases will be highlighted.
Conclusion: PWUDs who fail DAA treatment can be successfully retreated leveraging patient-centered
shared decision-making strategies.
Disclosure of Interest Statement:
The conference collaborators recognize the considerable contribution that industry partners make to
professional and research activities. We also recognize the need for transparency of disclosure of
potential conflicts of interest by acknowledging these relationships in publications and presentations.
Currently, Alain Litwin serves on the advisory board for Gilead Sciences, Inc. and Merck & Co. advisory
board and also has been awarded grants from Gilead Sciences, Inc. and Merck & Co.

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