PWID: HCV reinfection rate high after Tx through NSP program

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Takeaway

  • Real-world data show high HCV reinfection rates among people who inject drugs (PWID) successfully treated through a community needle and syringe program (NSP).

Why this matters

  • Rates greatly exceed reported estimates, suggesting a need for scaled-up harm reduction interventions in this population.

Study design

  • Prospective ERADICATE study of 94 patients in Dundee’s largest community NSP (mean age, 34±6.9 years; 71.3% male) treated for:
    • HCV-1 (n=37) with peginterferon/ribavirin (PR) + simeprevir/telaprevir.
    • HCV-2/3 (n=57) with PR.
  • Only individuals who had injected in the past week were eligible.
  • Funding: Scottish Government department of Public Health and Janssen Pharmaceuticals.   

Key results

  • 1 in 5 patients (20/94) was homeless or living in unstable accommodations.
  • 12.8% were incarcerated at some point during treatment.
  • 69.2% reported anxiety/depression; 39.4% had previously attempted suicide.
  • 68.1% were receiving opioid substitution therapy (OST) at baseline.
  • Median injections/week, 6.5; 54.3% reported injecting ≥1 injection(s) daily.
  • 71.3% of patients had treatment adherence ≥80%.
  • Rate of sustained virologic response at 12 weeks posttherapy (SVR12) was similar for HCV-1 (81.0%) and HCV-2/3 (82.5%).
  • 19.5% (15/77) patients had reinfection at 18 months posttreatment, corresponding with a rate of 21.49 per 100 person-years (95% CI, 13.00-35.65).

Limitations

  • Pilot study conducted before the shift to direct-acting antivirals.