Josh Estey/DFAT. Creative Commons licence.
Direct-acting
antiviral treatment cured almost everyone treated for hepatitis C in a large
cohort of people receiving opioid substitution therapy, Swiss researchers
report in the Swiss Medical Weekly.
The study
also observed a substantial fall in new hepatitis C diagnoses among people
receiving opioid substitution therapy (OST) during a two-year period after
direct-acting antiviral (DAA) treatment was made available to everyone with hepatitis
C in Switzerland regardless of liver disease stage.
A high level
of engagement in OST, mainly prescribed by general
practitioners, allows regular screening for hepatitis C and referral for
hepatitis C treatment. However, some countries have proved reluctant to provide DAA treatment to people on OST, citing concerns about adherence to DAA treatment and
hepatitis C reinfection among people who continue to inject drugs while
receiving OST.
The Swiss
Association for the Medical Management of Substance Users (SAMMSU) cohort has
recruited participants through OST programmes in eight towns and cities since
2014. Analyses of chronic hepatitis C prevalence, treatment uptake and cure
rates between 2017 and 2019 showed that by 2019, 79% of people who had tested
positive for hepatitis C had undergone hepatitis C treatment. Of those treated,
95% had either been cured or had a negative hepatitis C virus (HCV) viral load by 1 May 2019. The
prevalence of HCV viraemia in the cohort decreased from 36% in 2017 to 19% in
2019 among people who had tested positive for HCV antibodies.
Adherence to
DAA treatment was very good; 98% of participants had
excellent adherence. In the period between 2017 and 2019, 35 reinfections were
observed, a rate of 1.6 cases per 100 person-years of follow-up. New cases of
hepatitis C in people previously negative for hepatitis antibodies have fallen
from approximately 30 new diagnoses in 2013 to less than ten in 2019.
The researchers conclude that very high rates of treatment uptake are possible
in OST recipients with hepatitis C and that adherence and treatment success are
excellent. “Treating chronic hepatitis C in [OST] patients requires an extra
effort,” they conclude, highlighting several practices which support treatment
uptake:
- Switzerland introduced DAA prescribing by
general practitioners in 2019, allowing OST providers to offer hepatitis C
treatment on site, rather than referring patients to liver specialists.
- Dried blood spot sampling for HCV viral load testing and use of
APRI scores instead of Fibroscan to identify patients at highest risk of
fibrosis allow decentralised settings such as general practitioners or
pharmacies to diagnose chronic hepatitis C and assess patients for
treatment without the need for hospital referral.
- Directly observed treatment alongside OST supports adherence; 45%
of people received their treatment as a directly observed regimen.
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