Since the emergence of costly direct-acting antiviral drugs, much controversy has surrounded the issue of which patients with hepatitis C virus (HCV) should receive treatment. Due to the high costs of these drugs, some payers only granted access to patients with late-stage cirrhosis.
 
The opioid epidemic and related boom in injection drug use has resulted in even more questions: should people who inject drugs (PWID) receive HCV treatment and if these patients do receive payer approval, will they respond to therapy?
 
A new study published by the Lancet Gastroenterology & Hepatology suggests that a majority of PWID can achieve a sustained viral response at 12 weeks.
 
Included in the analysis were 103 patients with HCV genotypes 1 to 4 who reported using injection drugs in the previous 6 months. Patients were treated with daily sofosbuvir-velpatasvir for 12 weeks.
 
At baseline, approximately three-quarters of patients used injection drugs within the previous month and 60% of patients received opioid substitution treatment.
 
The authors found that 99 out of 100 patients who finished treatment achieved a response.
 
Approximately 94% of patients achieved a sustained virologic response at 12 weeks, which was the primary efficacy endpoint of the trial, according to the study. The authors found that there were no virological failures.
 
Injection drug use prior to and during HCV treatment was not observed to impact virologic response, according to the study.
 
Less than half of patients experienced a treatment-related adverse event and only 7% experienced a serious adverse event. There was also a single case of HCV re-infection observed, according to the authors.
 
Current guidelines suggest that PWID should receive treatment for HCV, but several factors—including stigma—may prevent physicians from prescribing the drugs.
 
 "Stigma ... has resulted in insurance restrictions and reluctance from providers to offer appropriate medical therapy,” the authors wrote.
 
The authors note that physicians should offer HCV therapy to PWID and that recent injection drug use should not justify withholding drug reimbursement, according to the study. 
 
These findings suggest that PWID with HCV "can and should be treated with direct-acting antivirals,” the authors concluded.