Z Gastroenterol 2018; 56(05): e30
DOI: 10.1055/s-0038-1654606
VORTRÄGE
Georg Thieme Verlag KG Stuttgart · New York

High virological cure rate and low rate of reinfection in a project to eradicate HCV in people who inject drugs at risk for non-adherence to direct-acting antivirals in Vienna

A Schütz
1   Suchthilfe Wien gGmbH, Ambulatorium Suchthilfe Wien, Vienna, Austria
,
C Schwanke
1   Suchthilfe Wien gGmbH, Ambulatorium Suchthilfe Wien, Vienna, Austria
,
E Gutic
2   Wilhelminenspital, Department of Internal Medicine IV, Vienna, Austria
,
T Lang
2   Wilhelminenspital, Department of Internal Medicine IV, Vienna, Austria
,
R Schubert
1   Suchthilfe Wien gGmbH, Ambulatorium Suchthilfe Wien, Vienna, Austria
,
J Luhn
1   Suchthilfe Wien gGmbH, Ambulatorium Suchthilfe Wien, Vienna, Austria
,
H Haltmayer
1   Suchthilfe Wien gGmbH, Ambulatorium Suchthilfe Wien, Vienna, Austria
,
M Gschwantler
2   Wilhelminenspital, Department of Internal Medicine IV, Vienna, Austria
› Author Affiliations
Further Information

Publication History

Publication Date:
09 May 2018 (online)

Also available at
 

Background and Aims:

An important subgroup of people who inject drugs (PWID) receiving opioid agonist therapy (OAT), cannot be treated in the setting of a hepatologic center and would not regularly ingest their medication when handed to them for self-administration. Our hypothesis was that chronic hepatitis C in these patients could be ideally managed if modern, interferon-free regimens were administered together with OAT under direct observation of a pharmacist, physician or nurse at a pharmacy or a low-threshold facility.

Method:

190 PWID on stable OAT with chronic hepatitis C and high risk for non-adherence to DAA-therapy (male/female: 145/45; mean age: 38.0 ± 8.3 years; genotype (GT) 1/2/3/4: 115/2/67/6; HIV-coinfection: 13 patients; liver cirrhosis: 42 patients) started interferon-free treatment of chronic hepatitis C. Patients received antiviral therapy together with OAT under direct observation of a pharmacist, physician or nurse at a pharmacy or low-threshold facility. The DAA-regimen was selected according to GT, fibrosis stage, pretreatment and current reimbursement policy of insurances.

Results:

Following this concept of directly observed therapy, adherence to antiviral therapy was excellent: Only 0.15% of scheduled dates were missed by the 190 patients. Till now, 134 patients have completed treatment and a 12-week follow-up period. Virological cure of hepatitis C infection (sustained virologic response, SVR12) could be confirmed in all 134 patients (SVR12 rate: 100%, 95% CI: 97.3 – 100.0). During follow-up reinfections occurred in 7 patients. The cumulative rate of reinfection 12, 24, 48 and 72 weeks after end of therapy was 2.2%, 5.1%, 7.5% and 7.5%, respectively.

Conclusion:

Directly observed therapy of chronic hepatitis C at a pharmacy or a low-threshold facility is highly effective in PWID at risk for non-adherence to DAA. By this new concept, a group of difficult-to-treat patients can be cured, who could not have been treated in settings of studies published so far.