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Treatment as Prevention: A Comprehensive Approach to Hepatitis C Virus in Persons Who Inject Drugs

With the increasing prevalence of HCV infections among PWIDs and the advent of well-tolerated DAAs with high cure rates, treatment is becoming a focus for HCV investigators worldwide. Two recent abstracts presented at the 2017 European Association for the Study of the Liver conference evaluated the use of DAAs in PWIDs.
The Simplify study was an open label, internation­al, multicenter, single-arm trial evaluating the use of sofosbuvir/velpatasvir in PWIDs who were infected with HCV, had compensated cirrhosis, and had injected drugs in the last 6 months. The overall SVR was 94%, with 96% of participants completing the 12-week treatment regimen. No cases of virologic failure were observed, but 1 participant did have virologic relapse/reinfection after completing therapy.9

Grebely et al presented the second abstract detailing a pooled analysis of 12 studies that evaluated the impact of OST on several outcomes, including adherence rates, efficacy, safety, and completion of therapy in patients receiving ombitasvir, paritaprevir/ritonavir, and dasabu­vir with or without ribavirin. The analysis demonstrated that the treatment completion rate was similar between patients receiving OST and those who were not (97% vs 98%, respectively), with slightly lower daily adherence rates in patients receiving OST (70% vs 88%). Despite the slightly lower adherence rate between the 2 arms, there was no statistically significant difference observed in the SVR rates for the OST participants achieving SVR rates of 94% versus those who did not participate 96% (P = .273).10

Adherence to HCV therapy in PWIDs has been demon­strated in multiple studies evaluating the adherence to, and efficacy of, interferon-based regimens. Based on the studies discussed above, demonstrating comparable efficacy rates in PWIDs, the AASLD and the Infectious Disease Society of America (IDSA) recommend not with­holding treatment for this patient population.

As recommended in the AASLD and IDSA guidelines, all patients should be offered treatment for HCV. Based on the literature discussed above demonstrating similar efficacy rates in PWIDs compared with patients not ac­tively using drugs, PWID should not be denied access to these medications solely based on their drug use. Treat­ment of PWID should use a comprehensive approach that combines behavioral counseling, SEPs, and access to medications to ensure these patients achieve the best outcome possible. This multidisciplinary approach may help to prevent transmission of new infections to others, as well as potential HCV reinfection.
Dr. Binkley earned her doctor of pharmacy degree at Philadelphia College of Pharmacy. She completed her PGY- 1 pharmacy practice residency and PGY- 2 infectious diseases residency at the Hospital of the University of Pennsylvania. She is an active member of SIDP.

  1. Thrift AP, El-Seraq HB, Kanwal F. Global epidemiology and burden of HCV infection and HCV-related disease. Nat Rev Gastroenterol Hepatol. 2017;14(2):122-132. doi: 10.1038/nrgastro.2016.176.
  2. Hagan H, Pouget E, Des Jarlais D. A systematic review and meta-analysis of interventions to prevent hepatitis C virus infection in people who inject drugs. J Infect Dis. 2011;204(1):74-83. doi: 10.1093/infdis/jir196.
  3. Suryaprasad A, White J, Xu F, et al.  Emerging Epidemic of Hepatitis C Virus Infections Among Young Nonurban Persons who Inject Drugs in the United States, 2006-2012.  Clin Infect Dis.  2014; 59(10):141-9.
  4. Page K, Morris MD, Hahn JA, Maher L, Prins M. Injection drug use and hepatitis C virus infection in young adult injectors: using evidence to inform comprehensive prevention. Clin Infect Dis. 2013;57(suppl 2):S32-S38. doi: 10.1093/cid/cit300.
  5. HCV guidance: recommendations for testing, managing, and treating hepatitis C. AASLD-IDSA website. Published April 2017.  Accessed May 15,2017.
  6. Garfein RS, Golub ET, Greenber AE, et al; DUIT Study Team. A peer-education intervention to reduce injection risk behaviors for HIV-hepatitis C virus infection in young injection drug users. AIDS. 2007;21(14):1923-1932.
  7. Stein MD, Herman DS, Anderson BJ. A trial to reduce hepatitis C seroincidence in drug users. J Addict Dis. 2008;28(4):389-398. doi: 10.1080/10550880903183034.
  8. Islam N, Krajden M, Shoveller J, et al. Impact of drug use and opioid substitution therapy on hepatitis C reinfection: The BC Hepatitis Testers Cohort. Presented at American Association for the Study of Liver Diseases; 2016; Boston, MA.
  9. Grebely J, Dalgard O, Conway B, et al. Efficacy and safety of sofosbuvir/velpatasvir in people with chronic hepatitis C virus infection and recent injection drug use: The SIMPLIFY study. Paper presented at European Association for the Study of the Liver; 2017; Amsterdam.
  10. Grebely J, Puoti M, Wedemeyer H, et al. Safety and efficacy of ombitasvir, paritaprevir/ritonavir and dasabuvir with or without ribavirin in chronic hepatitis C patients receiving opioid substitution therapy: a pooled analysis across 12 clinical trials. Paper presented at: European Association for the Study of the Liver; 2017; Amsterdam, the Netherlands.

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