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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End of treatment
Hepatitis C virus
Human immunodeficiency virus
People who do not inject drugs
Opioid substitution therapy
People who inject drugs
Sustained virologic response
World Health Organization
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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.
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). https://doi.org/10.1007/s00508-021-01868-1
- Hepatitis C virus
- Hepatitis eradication
- Adherence to treatment
- People who inject drugs, PWID
- Opioid substitution therapy, OST