HCV: DAA therapy feasible, effective in Italian prison settings

  • Pontali E & al.
  • Int J Drug Policy
  • 6 Jul 2018

  • curated by Yael Waknine
  • Univadis Clinical Summaries
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Takeaway

  • HCV treatment with direct-acting antivirals (DAAs) is feasible and effective in Italian penitentiary settings, where infection rates are estimated to range from 22.8%-38%.

Why this matters

  • High prevalence and risky behaviors render prisons an HCV reservoir for the entire community.
  • Since 2015, European Association for the Study of Liver Disease (EASL) guidelines have emphasized the importance of treating incarcerated individuals.

Study design

  • Study of 142 HCV-infected people incarcerated in 25 Italian prisons during May 2015 to October 2016, receiving sofosbuvir-based regimens.
  • Primary endpoint was sustained virologic response at 12 weeks posttherapy (SVR12).
  • Funding: None.   

Key results

  • Majority of patients were male (98.6%) of Italian nationality (93.7%); mean age was 50±7.5 years.
  • Cirrhosis was highly prevalent (76.1%), as were HCV genotypes 1a (35.9%) and 3 (35.9%).
  • 84% of infections were among intravenous drug users (IDU), of whom 38.6% were receiving opioid substitution therapy (OST).
  • 14.8% of patients were coinfected with HIV, of whom 95.2% received antiretroviral therapy.
  • Completion rate was 94.4%; 6 of 8 discontinuations were associated with prison release.
  • SVR12 was 90.8% (virologic failures, 3.5%; loss to follow-up, 5.6%).
  • SVR12 was high in patients with cirrhosis (90.7%), and among IDU (98.3%) and IDU on OST (97.8%).

Limitations

  • Homogenous population.

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