Real-world study of hepatitis C treatment with direct-acting antivirals in patients with drug abuse and opioid agonist therapy

Abstract

Background: Limited data exist evaluating the treatment outcomes with direct-acting antivirals (DAAs) in patients with drug use in the community setting. We aim to assess the treatment response of DAAs in this subset of patients with or without the opioid agonist therapy (OAT).

Methods: All the hepatitis C virus (HCV) infected patients treated with DAAs were retrospectively analyzed. Patients were stratified into two groups by the presence or absence of abusing alcohol, cocaine and heroin. All the patients who were assigned to the abuser group had positive urine toxicology with one of the drugs during the DAA treatment. The primary assessment was the sustained virologic response (SVR12) at 12 weeks post-treatment (SVR12).

Results: Among the 314 patients, 152, 128 and 58 were patients with drug use, non-drug use and receiving OAT. Among the patients with injectable or non-injectable drug use treatment, completion rate was 99% (151/152) and SVR12 was 93.4%. Among the patients with no drug use treatment, completion rate was 95% (122/128) and SVR12 was 88.3%. Among patients receiving OAT alone, SVR12 was 100%, and in patients with OAT + other drug use, SVR12 was 96.5%. None of the patients included in this study discontinued the treatment due to adverse events associated with treatment medications.

Conclusions: In this community-based study, DAAs are safe, effective with high overall SVR12 in patients with active drug use (injectable and non-injectable) and OAT enrolled patients. These results support the removal of drug use as a barrier to DAA therapy.

Keywords:

• Chronic hepatitis C
• direct-acting antivirals
• people who abuse drugs
• sustained virologic response
• adverse events

Disclosure statement

Dr. Mohanty is on the Speakers Bureau for Gilead Science, BMS and Abbvie Pharmaceuticals. Dr. Pan received grants from Gilead, Bristol Myers Squibb and Merck. He also serves as a consultant or advisor for Gilead, and speaker for Gilead, Abbvie and Intercept. For the remaining authors, there is no conflict of interest.