Integrated Care for the Use of Direct-acting Antivirals in Patients With Chronic Hepatitis C and Substance Use Disorder

J Addict Med. Sep/Oct 2018;12(5):346-352. doi: 10.1097/ADM.0000000000000415.

Abstract

Objectives: Since little is currently known about predictors of response to direct-acting antiviral agents (DAAs) in people who inject drugs, we undertook an analysis of patients attending a hepatitis clinic with addiction services (outpatient clinics and inpatient services) to examine the outcomes associated with the treatment of difficult-to-manage patients with substance use. Our experience was based on integrated care.

Method: A retrospective analysis was undertaken of 50 patients with hepatitis C virus (HCV) and a history of addiction who received treatment with DAAs, according to European guidelines. These regimens were sofosbuvir/ledipasvir for 8 weeks (n = 3), sofosbuvir/ledipasvir ± ribavirin for 12 weeks (n = 19), sofosbuvir/daclatasvir for 12 weeks (n = 20), sofosbuvir/simeprevir (n = 1), or sofosbuvir/daclatasvir for 24 weeks (n = 7). Characteristics of patients who did versus did not achieve a sustained virologic response (SVR) 12 weeks after treatment were compared by univariate analysis.

Results: Forty-two patients (84%) were male; mean age was 46.2 ± 7.3 years. Genotypes were 1 (n = 21), 2 (n = 4), 3 (n = 18), 4 (n = 6), or 6 (n = 1). Most patients were treatment-naïve (n = 38). Five patients had coinfection with human immunodeficiency virus (n = 4) or hepatitis B (n = 1), 28 (56%) had evidence of cirrhosis on FibroScan (>12.5 kPa), and 34 (68%) were receiving opioid substitution therapy. Psychiatric disease, illicit drug use, unemployment, and homelessness/precarious housing were common. Forty-five patients (90%) achieved SVR, 2 were lost to follow-up, and 3 had treatment relapse.

Conclusions: SVR was not significantly associated with sociodemographic or virological characteristics, treatment, social environment, alcohol/drug use, and adherence. Although adherence was slightly worse than in "usual" patients, it did not affect the SVR rate. In these difficult-to-manage patients with HCV and substance use disorder, the real-world SVR rate (90%) was similar to that in nonaddicted populations.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Antiviral Agents / therapeutic use*
  • Benzimidazoles / therapeutic use
  • Delivery of Health Care, Integrated*
  • Drug Therapy, Combination
  • Female
  • Fluorenes / therapeutic use
  • Genotype
  • Hepacivirus / drug effects
  • Hepatitis C, Chronic / drug therapy*
  • Humans
  • Imidazoles / therapeutic use
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Retrospective Studies
  • Ribavirin / therapeutic use
  • Simeprevir / therapeutic use
  • Substance-Related Disorders / complications*
  • Sustained Virologic Response
  • Treatment Outcome
  • Uridine Monophosphate / analogs & derivatives
  • Uridine Monophosphate / therapeutic use

Substances

  • Antiviral Agents
  • Benzimidazoles
  • Fluorenes
  • Imidazoles
  • ledipasvir, sofosbuvir drug combination
  • Ribavirin
  • Simeprevir
  • Uridine Monophosphate
  • daclatasvir