Brian Conway1, Dan Smyth2, Réjean Thomas3, Alex Wong4, Giada Sebastiani5, Curtis Cooper6, Hemant Shah7, Ritesh Kumar8, Gretty Deutsch9, Ted Watson9. 1. Vancouver Infectious Diseases Centre, Vancouver, British Columbia, Canada. 2. Centre for Research, Education and Clinical Care of At-Risk Populations (RECAP), Moncton, New Brunswick, Canada. 3. Clinique L'Actuel, Montreal, Quebec, Canada. 4. Saskatchewan Health Authority, Regina, Saskatchewan, Canada. 5. McGill University Health Centre, Montreal, Quebec, Canada. 6. Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. 7. University Health Network, Toronto, Ontario, Canada. 8. Merck & Co., Inc., Kenilworth, New Jersey, USA. 9. Merck Canada Inc., Kirkland, Quebec, Canada.
Abstract
BACKGROUND: Development of robust treatment programs among core transmitters (CT) of hepatitis C virus (HCV) are needed, including strategies to address reinfection risk. The aim of this study was to describe the effectiveness of direct-acting antiviral (DAA) treatment in CT versus non-CT populations and assess reinfection rates after successful treatment. METHODS: Characterizing Risk Behaviour and Reinfection Rates for Successful Programs to Engage Core Transmitters in HCV Elimination (C-RESPECT) was a prospective, observational study of HCV-infected Canadian adult patients (genotypes 1, 3, and 4) treated with DAAs between 2017 and 2020. RESULTS: The full analysis set included 429 participants (259 CT, 170 non-CT). Key differences were observed in baseline profiles: CT participants were younger (mean 42.3 [SD 11.2] y versus 55.0 [SD 11.1] y, respectively) and reported higher rates of social assistance (35.7% versus 14.8%), smoking (83.7% versus 52.4%), low socioeconomic status (yearly income <$15,000: 69.6% versus 43.9%), illicit drug use (83.7% versus 34.3%), and previous incarcerations (62.7% versus 36.9%). DAA treatment adherence was similar; 93 .5% versus 98.3% of CT versus non-CT participants completed the assigned treatment duration. Cure rates (sustained virologic response) were comparable, ranging from 94.9% to 98.1%. All reinfections were among CT participants, with a rate of 13.8/100 person-years (95% CI 9.2-20.8) with mean time to reinfection of 24.6 (SD 0.6) months. CONCLUSIONS: CT and non-CT participants respond equally well to DAA treatment; however, with some reinfections among CT participants. Innovative multidisciplinary programs must be developed to mitigate this risk in this key population.
BACKGROUND: Development of robust treatment programs among core transmitters (CT) of hepatitis C virus (HCV) are needed, including strategies to address reinfection risk. The aim of this study was to describe the effectiveness of direct-acting antiviral (DAA) treatment in CT versus non-CT populations and assess reinfection rates after successful treatment. METHODS: Characterizing Risk Behaviour and Reinfection Rates for Successful Programs to Engage Core Transmitters in HCV Elimination (C-RESPECT) was a prospective, observational study of HCV-infected Canadian adult patients (genotypes 1, 3, and 4) treated with DAAs between 2017 and 2020. RESULTS: The full analysis set included 429 participants (259 CT, 170 non-CT). Key differences were observed in baseline profiles: CT participants were younger (mean 42.3 [SD 11.2] y versus 55.0 [SD 11.1] y, respectively) and reported higher rates of social assistance (35.7% versus 14.8%), smoking (83.7% versus 52.4%), low socioeconomic status (yearly income <$15,000: 69.6% versus 43.9%), illicit drug use (83.7% versus 34.3%), and previous incarcerations (62.7% versus 36.9%). DAA treatment adherence was similar; 93 .5% versus 98.3% of CT versus non-CT participants completed the assigned treatment duration. Cure rates (sustained virologic response) were comparable, ranging from 94.9% to 98.1%. All reinfections were among CT participants, with a rate of 13.8/100 person-years (95% CI 9.2-20.8) with mean time to reinfection of 24.6 (SD 0.6) months. CONCLUSIONS: CT and non-CT participants respond equally well to DAA treatment; however, with some reinfections among CT participants. Innovative multidisciplinary programs must be developed to mitigate this risk in this key population.
Authors: Y Shiratori; F Imazeki; M Moriyama; M Yano; Y Arakawa; O Yokosuka; T Kuroki; S Nishiguchi; M Sata; G Yamada; S Fujiyama; H Yoshida; M Omata Journal: Ann Intern Med Date: 2000-04-04 Impact factor: 25.391
Authors: N Palmateer; S Hutchinson; G McAllister; A Munro; S Cameron; D Goldberg; A Taylor Journal: J Viral Hepat Date: 2013-05-28 Impact factor: 3.728