AASLD 2016: Treatment of People Who Inject Drugs
People who Inject Drugs (PWIDs) and who are infected with hepatitis C are not generally considered for hepatitis C treatment except in clinical trials. This is troubling because PWIDs are now the largest group of people who are at risk of acquiring hepatitis C. Additionally, a strategy to eliminate hepatitis C has to include a strategy to treat the most at-risk population. This year’s Conference included a presentation “Treatment of HCV in People Who Inject Drugs” by Jason Grebely. I am only going to cover the cure rates and re-infection rates from Dr. Grebely’s presentation.
Treatment: In various phase 3 clinical trials of people on HCV direct-acting antiviral medications the cure rates were 92% to 96% in people on opioid substitution therapy vs. 95% to 98% in people who were not on opioid substitution therapy (OST). In one of the largest clinical trials of people who inject drugs—C-EDGE Co-STAR (elbasvir/grazoprevir), genotypes 1, 4 and 6, treatment naïve patients, fibrosis stage F0 through F4, 12 week treatment duration the cure rate was genotype 1a: 96% (146 of 152 pts) ; genotype 1b: 97% (28 of 29 pts); genotype 4: 100% (11 of 11 pts); genotype 6: 60% (3 of 5 pts). The adherence in the group was 96%.
In other clinical trials of ‘real world’ study of people who inject drugs (heroin 66%; cocaine 62%; other stimulants 46%; OST 40%) and treated with different direct-acting antiviral medications the overall cure rate was 95%.
An overview of reinfection rates after being cured of hepatitis C among PWID were 2% to 3% in people who had a history of reinfection, 6% per year in people who injected drugs after achieving a cure and in one study presented at AASLD 4% per year in people on OST. There was no information given about prevention education—the most important component when treating people who are actively using drugs.
Alan Franciscus is the Executive Director of the Hepatitis Support Project and Editor-in-Chief of the HCV Advocate Website.
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