Research Highlights Efficacy of HCV Therapy in Drug Users, Urges Removal of Treatment Restrictions

In light of new evidence supporting the efficacy of hepatitis C virus (HCV) treatments in individuals who use or inject drugs, researchers are urging the removal of restrictions that prevent recent drug users from accessing lifesaving HCV therapies.

Although HCV treatments can be highly effective in curing the disease, these new therapies remain inaccessible to individuals who inject drugs in many countries due to restrictions on treatment reimbursement. Concerns about poor response to therapy and decreased adherence also prevent many clinicians from prescribing treatment to this population.

The systematic review, published in The Lancet Gastroenterology and Hepatology, assessed direct-acting antiviral (DAA) therapy for HCV infection among participants who use drugs. The researchers examined treatment completion, sustained virologic response (SVR), and loss to follow-up among those with recent drug use and those receiving opioid substitution therapy.

Data from 38 eligible studies including 3634 participants were included.

• Among 1408 individuals with recent injecting or non-injecting drug use, treatment completion was 97.5% and SVR was 87.7%.
• Among 2987 individuals receiving opioid substitution therapy, treatment completion was 97.4% and SVR was 90.7%.
• Among individuals with recent injecting drug use, treatment completion was 96.9% and SVR was 87.4%.

According to a meta-regression analysis, clinical trials and higher mean or median age were significantly associated with higher SVR. Clinical trials and older age were also significantly associated with a lower proportion of participants lost to follow-up.

Overall, the findings indicated that the response to HCV therapy among individuals with recent drug use, including those who inject, and individuals receiving opioid substitution therapy was favorable.

According to study author Jason Grebely, PhD, who is an associate professor from the Kirby Institute, the results provide evidence to support overturning policies that prevent individuals from receiving treatment based on their drug use.

“People should not be denied life-saving treatments, simply because of their recent drug use,” Dr Grebely said in a press release. “Policies that deny hepatitis C treatment for people who use or inject drugs are unacceptable; they are driven by discrimination as opposed to evidence.”

He noted that, given high prevalence rates, individuals with HCV who use drugs should be prioritized for treatment to reduce the risk of spreading infection through injection drug use.

Overturning these restrictive policies and broadening access to treatment can be effective in reducing HCV among this population, the researchers concluded.

References

Hajarizadeh B, Cunningham EB, Reid H, et al. Direct-acting antiviral treatment for hepatitis C among people who use or inject drugs: a systemic review and meta-analysis. The Lancet Gastroenterology and Hepatology. 2018. Doi: https://doi.org/10.1016/S2468-1253(18)30304-2

Overwhelming evidence demonstrates hepatitis C treatment effective for people who inject drugs [news release]. University of New South Wales’ website. http://newsroom.unsw.edu.au/news/health/overwhelming-evidence-demonstrates-hepatitis-c-treatment-effective-people-who-inject. Accessed September 21, 2018.