Rob Bielen1, Christophe Moreno2, Hans Van Vlierberghe3, Stefan Bourgeois4, Jean-Pierre Mulkay5, Thomas Vanwolleghem6, Wim Verlinden6, Christian Brixko7, Jochen Decaestecker8, Chantal De Galocsy9, Filip Janssens10, Mike Cool11, Lode Van Overbeke12, Christophe Van Steenkiste13, François D'heygere14, Wilfried Cools15, Frederik Nevens16, Geert Robaeys17. 1. Faculty of Medicine and Life Sciences, Hasselt University, Department of Gastro-Enterology and Hepatology, Ziekenhuis-Oost Limburg, Genk, Belgium. Electronic address: rob.bielen@uhasselt.be. 2. Department of Gastro-Enterology and Hepatopancreatology, Erasme Hospital, Brussels, Belgium. 3. Department of Hepatology and Gastro-Enterology, University Hospitals Gent, Belgium. 4. Department of Gastro-Enterology and Hepatology, ZNA Stuivenberg, Antwerp, Belgium. 5. Department of Gastro-Enterology and Hepatology, Hôpital Saint-Pierre, Brussels, Belgium. 6. Department of Gastro-Enterology and Hepatology, University Hospitals UZ Antwerpen, Antwerp. 7. Department of Gastroenterology and Digestive Oncology, CHR Citadelle, Liège, Belgium. 8. Department of Gastro-Enterology and Hepatology, AZ Delta, Roeselare, Department of Gastro-Enterology and Hepatology, University Hospitals KULeuven, Leuven, Belgium. 9. Department of Gastro-Enterology and Hepatology, Hôpital HIS Bracops, Brussels, Belgium. 10. Department of Gastro-Enterology and Hepatology, Jessa Hospital, Hasselt, Department of Gastro-Enterology and Hepatology, University Hospitals KULeuven, Leuven, Belgium. 11. Department of Gastro-Enterology and Hepatology, AZ Damiaan, Oostende, Department of Gastro-Enterology and Hepatology, University Hospitals KULeuven, Leuven, Belgium. 12. Department of Gastro-Enterology and Hepatology, AZ Sint Maarten, Mechelen, Belgium. 13. Department of Gastro-Enterology and Hepatology, AZ Maria Middelares, Gent, Department of Gastro-Enterology and Hepatology, University Hospitals Gent, Belgium. 14. Department of Gastro-Enterology and Hepatology, AZ Groeninge, Kortrijk, Department of Gastro-Enterology and Hepatology, University Hospitals KULeuven, Leuven, Belgium. 15. Faculty of Science, Center for Statistics, Hasselt University, Diepenbeek, Belgium. 16. Department of Gastro-Enterology and Hepatology, University Hospitals KULeuven, Leuven, Belgium. 17. Department of Gastro-Enterology and Hepatology, Ziekenhuis-Oost Limburg, Genk, Department of Gastro-Enterology and Hepatology, University Hospitals KULeuven, Leuven, Belgium.
Abstract
BACKGROUND AND AIM: Hepatitis C viral infection (HCV) has become a curable disease due to the development of direct acting antivirals (DAA). The WHO has set a target to eliminate HCV completely. Therefore, people who inject drugs (PWID) also need to be treated. In this study, we compared the real-life uptake and outcome of DAA treatment for HCV in PWID and non-PWID. METHODS: We performed a nation-wide, retrospective cohort study in 15 hospitals. All patients who were treated with simeprevir-sofosbuvir, daclatasvir-sofosbuvir, or ombitasvir/paritaprevir ritonavir-dasabuvir between December 2013 and November 2015 were included. RESULTS: The study population consisted of 579 patients: 115 PWID (19.9%) and 464 non-PWID (80.1%). Of the PWID 18 were active PWID (15.6%), 35 still received opiate substitution therapy (OST) (30.4%) and 62 were former PWID without OST (53.9%). PWID were more infected with genotype 1a and 3 (p=0.001). There were equal rates of side-effects (44.7% vs. 46.6%; p=0.847), similar rates of treatment completion (95.7% vs 98.1%; p=0.244) and SVR (93.0% vs 94.8%; p=0.430) between PWID and non-PWID, respectively. CONCLUSION: PWID, especially active users, are underserved for DAA treatment in real life in Belgium. Reimbursement criteria based on fibrosis stage make it difficult to treat PWID. Treatment adherence is similar in PWID and the general population, even in patients with active abuse. DAA were safe and effective in PWID despite the higher prevalence of difficult-to-treat genotypes. Based on these data more efforts to treat PWID are needed and policy changes are necessary to reach the WHO targets.
BACKGROUND AND AIM: Hepatitis C viral infection (HCV) has become a curable disease due to the development of direct acting antivirals (DAA). The WHO has set a target to eliminate HCV completely. Therefore, people who inject drugs (PWID) also need to be treated. In this study, we compared the real-life uptake and outcome of DAA treatment for HCV in PWID and non-PWID. METHODS: We performed a nation-wide, retrospective cohort study in 15 hospitals. All patients who were treated with simeprevir-sofosbuvir, daclatasvir-sofosbuvir, or ombitasvir/paritaprevir ritonavir-dasabuvir between December 2013 and November 2015 were included. RESULTS: The study population consisted of 579 patients: 115 PWID (19.9%) and 464 non-PWID (80.1%). Of the PWID 18 were active PWID (15.6%), 35 still received opiate substitution therapy (OST) (30.4%) and 62 were former PWID without OST (53.9%). PWID were more infected with genotype 1a and 3 (p=0.001). There were equal rates of side-effects (44.7% vs. 46.6%; p=0.847), similar rates of treatment completion (95.7% vs 98.1%; p=0.244) and SVR (93.0% vs 94.8%; p=0.430) between PWID and non-PWID, respectively. CONCLUSION: PWID, especially active users, are underserved for DAA treatment in real life in Belgium. Reimbursement criteria based on fibrosis stage make it difficult to treat PWID. Treatment adherence is similar in PWID and the general population, even in patients with active abuse. DAA were safe and effective in PWID despite the higher prevalence of difficult-to-treat genotypes. Based on these data more efforts to treat PWID are needed and policy changes are necessary to reach the WHO targets.
Authors: Geert Robaeys; Stefan Christensen; Damien Lucidarme; Amber Arain; Philip Bruggmann; Jan Kunkel; Sofia Keim; Martin Jäkel; Ralph DeMasi; Chris Liu; Isabelle Lonjon-Domanec; Graham R Foster Journal: Infect Dis Ther Date: 2017-05-05
Authors: Stephanie Popping; Valeria Cento; Carole Seguin-Devaux; Charles A B Boucher; Adolfo de Salazar; Eva Heger; Orna Mor; Murat Sayan; Dominique Salmon-Ceron; Nina Weis; Henrik B Krarup; Robert J de Knegt; Oana Săndulescu; Vladimir Chulanov; David A M C van de Vijver; Federico García; Francesca Ceccherini-Silberstein Journal: Viruses Date: 2021-12-22 Impact factor: 5.048