- Integrating direct-acting antivirals (DAAs) into opioid agonist treatment (OAT) or heroin-assisted treatment (HAT) yields excellent HCV clearance rates.
Why this matters
- Real-world study shows high clearance rates despite a high prevalence of psychiatric comorbidities, ongoing injection drug use (IDU), and alcohol abuse.
- Many addiction programs still do not offer integrated HCV care.
- Retrospective analysis of 64 patients (mean age, 48±8 years; 80% men) treated with DAAs during 2014-2017 in low-threshold access, primary care-based addiction medicine outpatient clinics in Zurich.
- Most were infected with genotype 1 (50%; 1a, 33%) or 3 (34%); 56% had cirrhosis (Child-Pugh A, 32/34).
- Primary endpoint: sustained virologic response at 12 weeks post-treatment (SVR12).
- Funding: None disclosed.
- 42 patients (66%) received OAT, and 22 (34%) received HAT.
- 41% reported alcohol abuse, and 9 acknowledged IDU during DAA therapy, most commonly cocaine; 78% had psychiatric comorbidities.
- Treatment support took the form of directly observed treatment, adherence support, or 28-day medication packages.
- Treatment completion rate, 100%.
- SVR12 rate, 92.2%.
- Of 5 non-SVR12 patients, 2 experienced virologic failure, and 3 achieved end-of-treatment response but were lost to follow-up.
- Excluding these latter 3, SVR12 rate was 96.7%.
- Small sample size.
- Self-reported drug/alcohol use.
- Retrospective design.