In the Journals

PWID similarly treatable for HCV as non-PWID

Treatment outcomes for chronic hepatitis C virus infection in people who inject drugs, or PWID, and patients on opioid substitution therapy are similar to those in patients without a history of injecting drugs, according to results from a systematic review and meta-analysis published in Clinical Infectious Diseases.

The researchers noted that these findings support current guideline recommendations for treating HCV infection in these patient populations.

“Chronic infection with [HCV] is a major global health concern, affecting approximately 71 million persons or 1% of the world’s population,” Christiana Graf, Dr.med, from the University Hospital Frankfurt, and colleagues wrote. “Injection drug use accounts for most new infections in Europe and the United States and is responsible for much of the ongoing spread of the disease.”

According to the researchers, recently approved direct-acting antivirals that target specific nonstructural proteins of the viral life cycle were a major breakthrough in HCV care because the infection can now be cured in more than 95% of patients across various populations. Although WHO issued its first global strategy on viral HBV and HCV in 2016, national plans for combatting viral hepatitis are lacking, they wrote. Thus, data on treatment outcomes among PWID and patients on opioid substitution therapy (OST) are scarce, and the researchers sought to address this gap in data.

In their analysis, they identified 11 primary articles and 12 conference abstracts, with a total of 1,702 patients on OST, 538 PWID and 19,723 controls. Among patients on therapy, the pooled SVR was 90% (95% CI, 87%-93%). The pooled discontinuation rate was 7% (95% CI, 4%-11%). Among PWID, the pooled SVR was 88% (95% CI, 80%-93%), and the pooled discontinuation rate was 9% (95% CI, 5%-15%). The researchers reported no significant difference in pooled SVR rates, adherence and discontinuation between patients on OST and controls, as well as between PWID and controls. Patients receiving OST had HCV reinfection rates ranging from 0 to 12.5 per person-years.

“In keeping with the WHO goal of global HCV eradication by 2030, we believe that current drug use or OST should not be a barrier to HCV treatment,” the researchers wrote. “However, long-term follow-up studies are needed to investigate the durability of SVR and the impact on overall morbidity and mortality in PWID and patients on OST.”

In a related editorial, Brianna L. Norton, DO, MPH, assistant professor of medicine at Montefiore Medical Center, and Alain H. Litwin, MD, vice chair for academics in the department of medicine at Greenville Health System in South Carolina, noted that “efforts to reach WHO elimination goals will never be reached if payors continue to have policies that specifically exclude people who use drugs.”

They also wrote that the evidence that PWID can be successfully cured is irrefutable.

However, “rapid treatment scale-up of this key population is the only approach to reduce transmission and incident infection,” they wrote. – by Joe Gramigna

Disclosures: Graf reports travel support from Gilead and speaking fees from AbbVie outside the submitted work. Litwin reports consulting work for Gilead, Merck and Abbvie, and institutional grants from Gilead and Merck. Norton reports grants from Merck and Co. outside the submitted work. Please see the study for all other authors’ relevant financial disclosures.

Treatment outcomes for chronic hepatitis C virus infection in people who inject drugs, or PWID, and patients on opioid substitution therapy are similar to those in patients without a history of injecting drugs, according to results from a systematic review and meta-analysis published in Clinical Infectious Diseases.

The researchers noted that these findings support current guideline recommendations for treating HCV infection in these patient populations.

“Chronic infection with [HCV] is a major global health concern, affecting approximately 71 million persons or 1% of the world’s population,” Christiana Graf, Dr.med, from the University Hospital Frankfurt, and colleagues wrote. “Injection drug use accounts for most new infections in Europe and the United States and is responsible for much of the ongoing spread of the disease.”

According to the researchers, recently approved direct-acting antivirals that target specific nonstructural proteins of the viral life cycle were a major breakthrough in HCV care because the infection can now be cured in more than 95% of patients across various populations. Although WHO issued its first global strategy on viral HBV and HCV in 2016, national plans for combatting viral hepatitis are lacking, they wrote. Thus, data on treatment outcomes among PWID and patients on opioid substitution therapy (OST) are scarce, and the researchers sought to address this gap in data.

In their analysis, they identified 11 primary articles and 12 conference abstracts, with a total of 1,702 patients on OST, 538 PWID and 19,723 controls. Among patients on therapy, the pooled SVR was 90% (95% CI, 87%-93%). The pooled discontinuation rate was 7% (95% CI, 4%-11%). Among PWID, the pooled SVR was 88% (95% CI, 80%-93%), and the pooled discontinuation rate was 9% (95% CI, 5%-15%). The researchers reported no significant difference in pooled SVR rates, adherence and discontinuation between patients on OST and controls, as well as between PWID and controls. Patients receiving OST had HCV reinfection rates ranging from 0 to 12.5 per person-years.

“In keeping with the WHO goal of global HCV eradication by 2030, we believe that current drug use or OST should not be a barrier to HCV treatment,” the researchers wrote. “However, long-term follow-up studies are needed to investigate the durability of SVR and the impact on overall morbidity and mortality in PWID and patients on OST.”

In a related editorial, Brianna L. Norton, DO, MPH, assistant professor of medicine at Montefiore Medical Center, and Alain H. Litwin, MD, vice chair for academics in the department of medicine at Greenville Health System in South Carolina, noted that “efforts to reach WHO elimination goals will never be reached if payors continue to have policies that specifically exclude people who use drugs.”

They also wrote that the evidence that PWID can be successfully cured is irrefutable.

However, “rapid treatment scale-up of this key population is the only approach to reduce transmission and incident infection,” they wrote. – by Joe Gramigna

Disclosures: Graf reports travel support from Gilead and speaking fees from AbbVie outside the submitted work. Litwin reports consulting work for Gilead, Merck and Abbvie, and institutional grants from Gilead and Merck. Norton reports grants from Merck and Co. outside the submitted work. Please see the study for all other authors’ relevant financial disclosures.