Direct acting antiviral-based treatment of hepatitis C virus infection among people who inject drugs in Georgia: A prospective cohort study

Int J Drug Policy. 2018 Dec:62:104-111. doi: 10.1016/j.drugpo.2018.07.016. Epub 2018 Oct 30.

Abstract

Background: People who inject drugs (PWID) are often excluded from HCV treatment programs due to concerns about their ability to adhere to care. Georgia has a high prevalence of HCV infection (5.4% of chronic cases in general population) with an epidemic concentrated among PWID. We evaluated adherence to care and sustained virologic response (SVR) among PWID in Georgia.

Methods: In this observational study, participants with recent injecting drug use (previous 6 months) and chronic HCV attending a needle- and syringe-program were included. Participants received sofosbuvir and ribavirin +/- pegylated interferon, with peer-based support during treatment. The primary endpoint was undetectable HCV RNA 12 weeks post-treatment (SVR12). Factors associated with SVR were assessed using logistic regression.

Results: Among 244 participants [HCV genotype (GT) 3, 52%; GT2, 25%; GT1, 19%; mixed GT, 4%]; 55% had cirrhosis. Overall, 24% were receiving OST and 50% injected drugs in the previous month. 98% (239 of 244) completed treatment, with 88% (210 of 239) having never delayed a medical appointment and 79% (189 of 239) never missing a dose of medication. Overall, SVR was 84.8% (207 of 244). SVR was 88.5% (207 of 234) among participants who attended 12-week follow up appointment for HCV RNA testing. In multivariate analyses, SVR was significantly associated with adherence (no missed doses) to treatment [vs. missed doses; adjusted OR (aOR) 2.77; 95% confidence interval (95%CI), 1.01-7.51), and genotype (vs. GT1; GT2, aOR 0.27; 95%CI 0.06-1.21; GT3, aOR 1.09; 95%CI 0.27-4.50; and mixed GT, aOR 0.14; 95%CI 0.02-0.97).

Conclusion: In this real-life study in a middle-income country, PWID treated for HCV and receiving a simple peer-support intervention demonstrated an excellent treatment response and good adherence, not associated with injecting drug use during treatment and OST at treatment initiation.

Keywords: Adherence; Direct acting antiviral; Hepatitis C virus; Middle income country; People who inject drugs; SVR.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Antiviral Agents / therapeutic use*
  • Cohort Studies
  • Drug Therapy, Combination
  • Drug Users*
  • Female
  • Genotype
  • Georgia
  • Hepacivirus / genetics
  • Hepatitis C, Chronic / drug therapy*
  • Humans
  • Interferon-alpha / therapeutic use
  • Liver Cirrhosis
  • Male
  • Middle Aged
  • Prospective Studies
  • Ribavirin / therapeutic use
  • Sofosbuvir / therapeutic use
  • Substance Abuse, Intravenous / virology*

Substances

  • Antiviral Agents
  • Interferon-alpha
  • Ribavirin
  • Sofosbuvir