Z Gastroenterol 2020; 58(05): e98
DOI: 10.1055/s-0040-1712308
Hepatologie

Challenges in hepatitis C elimination despite highly effective antiviral agents - experience of a tertiary Hepatology center

S Bota
Hepatology, Endocrinology, Rheumatology, Department of Internal Medicine and Gastroenterology (IMuG),Klagenfurt, Austria.
,
C Urak
Hepatology, Endocrinology, Rheumatology, Department of Internal Medicine and Gastroenterology (IMuG),Klagenfurt, Austria.
,
M Razpotnik
Hepatology, Endocrinology, Rheumatology, Department of Internal Medicine and Gastroenterology (IMuG),Klagenfurt, Austria.
,
F Hucke
Hepatology, Endocrinology, Rheumatology, Department of Internal Medicine and Gastroenterology (IMuG),Klagenfurt, Austria.
,
K Flatscher
Hepatology, Endocrinology, Rheumatology, Department of Internal Medicine and Gastroenterology (IMuG),Klagenfurt, Austria.
,
M Peck-Radosavljevic
Hepatology, Endocrinology, Rheumatology, Department of Internal Medicine and Gastroenterology (IMuG),Klagenfurt, Austria.
› Author Affiliations
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    Aim to investigate the adherence to treatment, SVR rate, and reinfection rate in hepatitis C patients with and without intravenous drug use.

    Methods Our retrospective study included patients with hepatitis C, which were evaluated between 01/2014-08/2019.

    Results We included 431 hepatitis C patients(234 PWIDs and 197 non-PWIDs). The percentage of men was higher in the PWIDs as compared with non-PWIDs group:71.8 % vs.55.4 %,p = 0.0006. HIV coinfection rate was similar between the two cohorts:0.8 % vs.1 %,p = 0.76. Positive viral load rate was lower in the PWIDs group. Genotype 1b was predominant in patients without i.v. drug use, while genotype 3 was more common in the PWIDs group. Most of the patients were treated with DAAs only (Table). The proportion of patients not starting therapy was significantly higher in the PWIDs cohort: 19.4 % vs.8.9 %,p = 0.003. Non-compliance(did not show up to start therapy) rate or refusal of therapy was also significantly higher in the PWIDs cohort:15 % vs.6.7 %,p = 0.01. In the PWIDs cohort, younger age and recent(in the last 6 months) or ongoing i.v. drug use was associated with non-compliance: 31.1 ± 8.4 vs.35.8 ± 10.6 years, p = 0.02 and 33.3 % vs. 12.8 %respectively,p = 0.0008. Ongoing OST was associated with better compliance:61.1 % vs.46.1 %,p = 0.04.

    Conclusion To achieve hepatitis C elimination, better strategies especially regarding PWIDs are needed.

    Tab. 1

    PWIDs (n = 234)

    Non-PWIDs (n = 197)

    Positive viral loadHCV genotype

    n = 206 (88 %)3:n = 97 (48.1 %) 1a:n = 67 (33.1 %) 1b:n = 18 (8.9 %)

    n = 192 (97.4 %)1b:n = 85 (44.5 %) 1a:n = 52 (27.2 %) 3: n = 24 (12.5 %)

    First therapy regime: - PegIFN+Ribavirin -DAA+PegIFN+Ribavirin -DAA+Ribavirin -DAAReinfection

    n = 12(7.2 %) n = 5(3 %) n = 23(13.9 %) n = 126(75.9 %)n = 9(4.3 %)

    n = 1(0.6 %) n = 5(2.8 %) n = 49(28 %) n = 120(68.6 %)n = 0(0 %)

    Currently therapy status -SVR - Viral load negative EOT, but patients did not show up to SVR12 visit - Viral load negative at EOT and SVR12 visit will follow - Therapy discontinued -Relapse (without further therapy) -Under therapy -without therapy

    n = 97(47.2 %) n = 47(22.8 %) n = 11(5.3 %) n = 2(0.9 %) n = 0(0 %) n = 9(4.4 %) n = 40(19.4 %)

    n = 151(78.7 %) n = 10(5.3 %) n = 7(3.6 %) n = 1(0.5 %) n = 2(1 %) n = 4(2 %) n = 17(8.9 %)

     

    Publication History

    Article published online:
    26 May 2020

    © Georg Thieme Verlag KG
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