HCV: integration of DAAs with OAT, HAT yields excellent results in Swiss study

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Takeaway

  • 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.

Study design

  • 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.

Key results

  • 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%.

Limitations

  • Small sample size.
  • Self-reported drug/alcohol use.
  • Retrospective design.