INHSU 2018—Management of HCV in people who inject drugs


  • Maria Joao Almeida
  • HCV Conference Reports
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Takeaway

  • Hepatitis C treatment has been shown to be safe and effective in people who inject drugs (PWID), with an increase in quality of life after sustained virologic response (SVR).

Why this matters

  • PWID are a priority population for the scale-up of HCV testing, linkage to care, and treatment, given the high burden of HCV in this population[1].
  • There are restrictions for the reimbursement of direct-acting antivirals (DAA) therapy for people with ongoing drug use in the USA and Europe[1].
  • Reinfection and adherence to treatment are reported as the most important concerns among clinicians [2].
  • There are 6 million PWID left to be treated [3].
  • HCV infection needs to cured in order to prevent the complications of HCV-related liver and extra-hepatic diseases, including hepatic necro-inflammation, fibrosis, cirrhosis, decompensation of cirrhosis, hepatocellular carcinoma, and death [4].
  • It is important to develop patient-reported measures for PWID undertaking DAAs [5].

Key results

  • Under clinical trial conditions, SVR12 rates that exceed 90% can be achieved with currently available, simple, well-tolerated oral therapies directed against HCV infection, as long as patients are able to complete treatment and follow-up, and treatment starts can be maintained [3].
  • Social treatment among PWID will only be achieved if healthcare systems are used as agents of social change [3].
  • The HCV infection cure improves quality of life, removes stigma, and prevents onward transmission of HCV [3].
  • Patient-reported measures might be even more important for patient groups that typically experience marginalization and lesser standing in society [3].
  • There is a need for careful engagement with vulnerable clients, and the choice/logic of care should be determined by them [3].

Limitations

  • Studies needed to access rates and patterns of recurrent hepatocellular carcinoma.
  • Lack of a best model of care for patients with mild fibrosis who achieve an SVR. 

Expert comment

  • Carla Treloar, Professor at the University of South Wales, Sydney, Australia, added that, “My work really tries to look at what is beyond the cure of hepatitis C; what are the important things in people’s lives? What do they worry about: some of the things are related to hepatitis C like liver health and test results, and other things are bigger and broader: hepatitis C cure to people with structural disadvantages. If we can, we should try to think about on how to address that along way with hepatitis C treatment.”
 

 

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