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Challenges in hepatitis C elimination despite highly effective antiviral agents in patients with and without intravenous drug use



To assess the adherence to treatment, sustained virologic response (SVR) rate, and reinfection rate in hepatitis C patients with and without intravenous drug use.


This retrospective study included hepatitis C patients, evaluated and treated in our hepatology outpatient clinic between January 2014 and October 2019.

The following information was extracted from the patient’s file: the presence of positive viral load for hepatitis C virus (HCV), active and recent (in the last 6 months) use of i.v. drugs, HCV genotype, treatment regimen, SVR, HCV reinfection rate, coinfection with human immunodeficiency virus (HIV) and ongoing opioid substitution therapy (OST).


We included 431 hepatitis C patients, 234 people who inject drugs (PWID) and 197 non-PWID. Most patients were treated with direct-acting antivirals (DAA) only.

The rate of documented SVR by treated patients was significantly higher in the non-PWID cohort (91.5% vs. 61.5%, p < 0.0001), while noncompliance (did not show up to start treatment) rate or refusal of treatment was significantly higher in the PWID cohort (19.4% vs. 8.9%, p = 0.004).

In the PWID cohort, younger age and recent (in the last 6 months) or ongoing i.v. drug use was associated with noncompliance: 31.1 ± 8.4 years vs. 35.8 ± 10.6 years (p = 0.02) and 33.3% vs. 12.8% (p = 0.0008), respectively.

Ongoing OST was associated with better compliance: 61.1% vs. 46.1% (p = 0.04).


To achieve elimination of hepatitis C better treatment strategies are needed, especially in PWIDs.

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Direct-acting antivirals


End of treatment


Hepatitis C virus


Human immunodeficiency virus


People who do not inject drugs


Opioid substitution therapy


Pegylated interferon


People who inject drugs


Sustained virologic response


World Health Organization


  1. 1.

    WHO. Global surveillance and control of Hepatitis C. Report of a WHO Consultation organized in collaboration with the Viral Hepatitis Prevention Board, Antwerp, Belgium. J Viral Liver. 1999;6:34–5.

    Google Scholar 

  2. 2. Accessed: 12. October 2020.

  3. 3.

    Kandeel A, Genedy M, El-Refai S, et al. The prevalence of hepatitis C virus infection in Egypt 2015: implications for future policy on prevention and treatment. Liver Int. 2017;37:45–53.

    CAS  Article  Google Scholar 

  4. 4.

    Gheorghe L, Csiki IE, Iacob S, et al. The prevalence and risk factors of hepatitis C virus infection in adult population in Romania: a nationwide survey 2006–2008. J Gastrointestin Liver Dis. 2010;19:373–9.

    PubMed  Google Scholar 

  5. 5. Accessed 28 Mar 2020.

  6. 6.

    The Polaris Observatory HCV Collaborators. Global prevalence and genotype distribution of hepatitis C virus infection in 2015: a modelling study. Lancet Gastroenterol Hepatol. 2017;2:161–76.

    Article  Google Scholar 

  7. 7.

    Di Bisceglie AM, Martin P, Kassianides C, et al. Recombinant interferon alfa therapy for chronic hepatitis C. A randomized, double-blind, placebo-controlled trial. N Engl J Med. 1989;321:1506–10.

    Article  Google Scholar 

  8. 8.

    Chemello L, Cavalletto L, Bernardinello E, et al. The effect of interferon alfa and ribavirin combination therapy in naive patients with chronic hepatitis C. J Hepatol. 1995;23(Suppl 2):8–12.

    CAS  PubMed  Google Scholar 

  9. 9.

    Manns MP, McHutchison JG, Gordon SC, et al. Peginterferon alfa-2b plus ribavirin compared with interferon alfa-2b plus ribavirin for initial treatment of chronic hepatitis C: a randomised trial. Lancet. 2001;358:958–65.

    CAS  Article  Google Scholar 

  10. 10.

    Marcellin P, Cheinquer H, Curescu M, et al. High sustained virologic response rates in rapid virologic response patients in the large real-world PROPHESYS cohort confirm results from randomized clinical trials. Hepatology. 2012;56:2039–50.

    CAS  Article  Google Scholar 

  11. 11.

    Afdhal N, Reddy KR, Nelson DR, et al. Ledipasvir and sofosbuvir for previously treated HCV genotype 1 infection. N Engl J Med. 2014;370:1483–893.

    CAS  Article  Google Scholar 

  12. 12.

    Afdhal N, Zeuzem S, Kwo P, et al. ION‑1 Investigators. Ledipasvir and sofosbuvir for untreated HCV genotype 1 infection. N Engl J Med. 2014;370:1889–98.

    Article  Google Scholar 

  13. 13.

    Toyoda H, Atsukawa M, Watanabe T, et al. Real-world experience of 12-week direct-acting antiviral regimen of glecaprevir and pibrentasvir in patients with chronic hepatitis C virus infection. J Gastroenterol Hepatol. 2019;

    Article  PubMed  Google Scholar 

  14. 14.

    Buggisch P, Wursthorn K, Stoehr A, et al. Real-world effectiveness and safety of sofosbuvir/velpatasvir and ledipasvir/sofosbuvir hepatitis C treatment in a single centre in Germany. PLoS ONE. 2019;14:e214795.

    CAS  Article  Google Scholar 

  15. 15.

    World Health Organization. Global health sector strategy on viral hepatitis, 2016–2021. Geneva: World Health Organization; 2016.

    Google Scholar 

  16. 16.

    Heffernan A, Cooke GS, Nayagam S, et al. Scaling up prevention and treatment towards the elimination of hepatitis C: a global mathematical model. Lancet. 2019;393:1319–29.

    Article  Google Scholar 

  17. 17.

    Pedrana A, Howell J, Schröder S, et al. Eliminating viral hepatitis: the investment case. Doha: World Innovation Summit for Health; 2018.

    Google Scholar 

  18. 18. Accessed 28 Mar 2020.

  19. 19.

    Burnet Institute. The Prime study: treating hepatitis C in primary healthcare setting. 2018. Accessed: 12. October 2020.

  20. 20.

    Litwin AH, Agyemang L, Akiyama M, et al. The PREVAIL Study: Intensive models of HCV care for people who inject drugs. J Hepatol. 2017;66(Supplement):72.

    Article  Google Scholar 

  21. 21.

    Schmidbauer C, Schuetz A, Schwanke C, et al. Interim results of an ongoing project to eliminate chronic hepatitis C in people who inject drugs with ongoing intravenous drug use and a high risk of non-adherence to direct-acting antivirals in Vienna. J Hepatol. 2019;70:e239.

    Article  Google Scholar 

  22. 22.

    Alimohammadi A, Holeksa J, Thiam A, et al. Real-world efficacy of direct-acting antiviral therapy for HCV infection affecting people who inject drugs delivered in a multidisciplinary setting. Open Forum Infect Dis. 2018;5:ofy120.

    Article  Google Scholar 

  23. 23.

    Lampertico P, Carrión JA, Curry M, et al. Real-world effectiveness and safety of glecaprevir/pibrentasvir for the treatment of patients with chronic HCV infection: a meta-analysis. J Hepatol. 2020;

    Article  PubMed  PubMed Central  Google Scholar 

  24. 24.

    Rossi C, Butt ZA, Wong S, et al. Hepatitis C virus reinfection after successful treatment with direct-acting antiviral therapy in a large population-based cohort. J Hepatol. 2018;69:1007–14.

    Article  Google Scholar 

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Corresponding author

Correspondence to Markus Peck-Radosavljevic.

Ethics declarations

Conflict of interest

M. Peck-Radosavljevic declares consultation and speaker fees from AbbVie, Gilead, MSD. S. Bota: declares speaker fees from AbbVie. F. Hucke, C. Urak, K. Flatscher and M. Razpotnik declare that they have no competing interests.

Ethical standards

This study was approved by the ethics committee of our institution (approval number A38/18), and the study protocol conforms to the ethical guidelines of the 1975 Declaration of Helsinki as reflected in a priori approval by the institution’s human research committee.

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Bota, S., Razpotnik, M., Hucke, F. et al. Challenges in hepatitis C elimination despite highly effective antiviral agents in patients with and without intravenous drug use. Wien Klin Wochenschr 133, 641–646 (2021).

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  • Hepatitis C virus
  • Hepatitis eradication
  • Adherence to treatment
  • People who inject drugs, PWID
  • Opioid substitution therapy, OST