Previously thought to be difficult or impossible, one study found HCV and drug use can be treated concurrently in young adults.
Successful treatment of hepatitis C virus (HCV) continues to prove difficult. One reason for this is the injection drug use frequently observed among infected persons.
While HCV cure has been accomplished in older adults who had not used drugs for at least 6 months prior to treatment, it has not been adequately studied or reported in people who inject drugs (PWIDS) and are younger than 35 years of age.
One study, presented during a poster session at the recent IDWeek Conference, studied precisely this population. The investigators identified and recruited active PWIDS, who were positive for HCV, had injected drugs in the last 6 months, and were no older than 35 years.
A total of 30 participants were included, 18 of whom were female. The average age was 28, within a range of 23-35 years. Recent injection drug use was frequently reported, with 73% (n = 22) having injected within the past 30 days; all patients had used injection drugs within the last 3 months.
They were treated for HCV with glecaprevir/pibrentasvir (G/P), and concurrently treated for opiate use disorder with XR Naletrexone (XR-NTX). Of the 30 patients, 2 chose to be treated with methadone.
Participants were evaluated for adherence, side effects, alanine aminotransferase (ALT) levels, and urine drug screens (UDS). They also completed opioid craving scores via a visual analog scale while on XR-NTX to assess how they were coping with their addiction.
The average ALT upon enrollment was 106. Of the 30 patients, 15 neglected to come to the required 2 visits before initiating G/P. Patient follow-up lasted for 12 months after enrollment. Lost-to-follow-up occurred due to addiction relapse (n = 9), overdose death (n = 1), and lost communication due to suspected relapse (n = 4).
Notably, of the 15 that began and completed G/P, all 15 were cured of their HCV infection. Patients were on XR-NTX for an average of 4.8 months, and 17 of the 30 received at least 1 dose of XR-NTX. The most commonly reported side effect of XR-NTX was mild injection site irritation.
Over the course of the study, the investigators noted “excellent control of craving and significant declines positive UDS.”
This research proved that young people who actively use injection drugs can be cured of HCV. Additionally, addiction can be concurrently managed with XR-NXT. “Our findings suggest it is safe to treatment active users with active HCV with XR-NXT improving elimination goals,” the study authors concluded.
This study, “Treating Hepatitis C Virus (HCV) in Young Adult Active Drug Users Is Possible,” was presented at a poster session during the IDWeek 2022 conference, held October 19-23 in Washington, D.C.