Skip to main content
SpringerLink
Log in

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

  • original article
  • Published:
Wiener klinische Wochenschrift Aims and scope Submit manuscript

Summary

Aim

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

Methods

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).

Results

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).

Conclusion

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

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

DAA:

Direct-acting antivirals

EOT:

End of treatment

HCV:

Hepatitis C virus

HIV:

Human immunodeficiency virus

Non-PWID:

People who do not inject drugs

OST:

Opioid substitution therapy

PegIFN:

Pegylated interferon

PWID:

People who inject drugs

SVR:

Sustained virologic response

WHO:

World Health Organization

References

  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. https://www.who.int/news-room/fact-sheets/detail/hepatitis-c. Accessed: 12. October 2020.

  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.

    Article  CAS  Google Scholar 

  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. https://cdafound.org/dashboard/polaris/maps_prev.html. Accessed 28 Mar 2020.

  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. 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. 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. 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.

    Article  CAS  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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.

    Article  CAS  Google Scholar 

  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. 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; https://doi.org/10.1111/jgh.14874.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  Google Scholar 

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

    Google Scholar 

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

    Google Scholar 

  18. https://cdafound.org/dashboard/polaris/maps.html#pablo. Accessed 28 Mar 2020.

  19. Burnet Institute. The Prime study: treating hepatitis C in primary healthcare setting. 2018. www.burnet.edu.au. Accessed: 12. October 2020.

  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. 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. 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. 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; https://doi.org/10.1016/j.jhep.2020.01.025.

    Article  PubMed  PubMed Central  Google Scholar 

  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 

Download references

Author information

Authors and Affiliations

  1. Department of Internal Medicine and Gastroenterology (IMuG), Hepatology, Endocrinology, Rheumatology and Nephrology and Emergency Medicine (ZAE), Klinikum Klagenfurt am Wörthersee, Feschnigstr. 11, 9020, Klagenfurt am Wörthersee, Austria

    Simona Bota, Marcel Razpotnik, Florian Hucke, Christian Urak, Kerstin Flatscher &  Markus Peck-Radosavljevic

Authors
  1. Simona Bota
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marcel Razpotnik
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Florian Hucke
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Christian Urak
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kerstin Flatscher
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Markus Peck-Radosavljevic
    View author publications

    You can also search for this author in PubMed Google Scholar

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.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00508-021-01868-1

Keywords

Search

Navigation