Feasibility and Efficacy of Direct-Acting Antiviral Therapy for Treatment of Hepatitis C Infection in a Low Threshold Setting

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

Theme: Clinical Research Year: 2017

Approximately 50% of people who inject drugs (PWID) in Oslo have chronic Hepatitis C (HCV) infection. We aim at assessing the feasibility of direct-acting antiviral therapy among people with recent injecting drug use.

A low-threshold HCV clinic was opened in 2013 in collaboration between The City of Oslo and Akershus University Hospital and is staffed with two nurses, a general practitioner and supported by a specialist in infectious diseases. Patients who had received minimum one dose of DAA and had injected the three months prior to treatment initiation were included. Eligibility for treatment criteria were significant fibrosis (liver stiffness measurement (LSM) ≥ 7 kPa), cirrhosis (LSM ≥ 12.5 kPa) and from March 2017 genotype 1 infection. The primary endpoint was sustained virological response at 4 weeks after the end of treatment (SVR4). Adherence to therapy ( 90% of prescribed doses) was a secondary endpoint.

Of 68 included patients (mean age 49 years, 78% male, 43% cirrhosis) 53% had genotype 1, 12% had genotype 2 and 35% had genotype 3. 76% (52/68) of patients received opiate substitution therapy and 90% (61/68) injected during treatment. DAA regimens containing pegylated interferon were given to 6% (4/68) of patients. Among 53 patients who were due to reach SVR4 examination by May 2017 89% (48/53) completed treatment and 98% reported adherence to therapy. Six patients discontinued treatment (side effect, n=1; fear of side effects, n=4; other illness, n=1) whereof SVR4 was achieved in one. SVR 4 was achieved in 85% (39/46) (HCV RNA missing, n=5; virological failure, n=2). Remaining SVR4 data will be reported.

In our patients with recent injecting drug use HCV treatment with DAA showed a fair treatment completion, high adherence and high efficacy. Fear of side effects was the main challenge in retention in care.

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