DAA therapy for chronic hepatitis c infection: risk factors for nonadherence and relapse

Background and Aims Antiviral therapy of HCV infection was revolutionized by the advent of direct antiviral agents. With pan-genotypic fix-dose drug combination, treatment is now offered to all patients with chronic HCV infection, with the goal of HCV elimination. Therefore, patients in marginalized groups at high risk of nonadherence must be reached. Data on risk factors for nonadherence and lost to follow up are scarce. Hall in Tirol is a HCV therapy centre with a large service for the treatment of opioid dependency, offering the opportunity to link opioid subsitution therapy (OST) to HCV treatment.

Method Retrospective cohort study on adherence to scheduled visits, virologic outcome, demographic data, data on risk factors for HCV infection, baseline virus load, virus genotype, and concurrent medical conditions. Lost to follow up (LTFU) was defined as disruption of documentation before SVR12 was reached.

Results Out of 216 patients referred, 50 persons did not start with treatment. 166 patients started DAA therapy. In 30 patients, follow up was incomplete. 61 patients had a history of IVDA, of which 37 were under OST. 53 patients were IFN treatment experienced. LTFU was most frequent in patients in active OST (13 out of 37), whereas patients with a history of IVDA, but no need for subsitution, exhibited comparable risks of LTFU. Patients with LTFU were younger, but did not differ significantly in other demographic criteria. Genotype 3 was more frequent in the subgroup of IVDA patients completing follow-up, their relapse rates were not elevated.

Conclusion Patients with intravenous drug abuse with a need for OST are at high risk for nonadherence to visits and prone to LTFU. Measures such as a close link of OST and DAA dispense as well as close communication between hepatologic and psychiatric services should be ensured to limit the risk of ineffective therapies.

Publication History

Article published online:
26 May 2020