An eight-week course of sofosbuvir/velpatasvir (Epclusa)
cured almost all people with hepatitis C genotype 3 without cirrhosis receiving
treatment alongside opioid substitution therapy through community pharmacies or
prisons in the Greater Glasgow area, Alison Boyle of Gartnavel Hospital,
Glasgow, reported at the 2018 International Liver Congress in Paris on
Genotype 3 is especially common in people who inject drugs and former drug users.
It has been considered 'harder to cure' although recent studies of newer agents
in people with genotype 3 have shown high cure rates.
A 12-week treatment course of sofosbuvir/velpatasvir (Epclusa) is highly effective in curing
genotype 3 hepatitis C infection and an 8-week course of sofosbuvir/velpatasvir
was highly effective in previously untreated people with genotype 3 infection
and no cirrhosis.
Scottish investigators carried out an observational study of
an 8-week course of sofosbuvir/velpatasvir in people receiving opioid
substitution therapy in the Glasgow area. The 8-week treatment course was
offered to drug users receiving opioid substitution therapy if they had F2 or
F3 fibrosis with the intention of maximising the number of people who could be
treated within a fixed drug budget in the Greater Glasgow region.
Sofosbuvir/velpatasvir was dispensed as daily
directly observed treatment along with opioid substitution therapy for those still
injecting or those who were in the early stages of recovery. More stable
patients received medication and opioid substitution therapy two to three times a week. All medication
was dispensed by community pharmacies with the exception of treatment provided
to people in prison.
Ninety people were observed in the study; 80% were male,
with a mean age of 46 years. Two-thirds had F2 fibrosis, 31% had F3 fibrosis and
the remainder had F1 or F0 fibrosis. Five were receiving opioid substitution
therapy in prison. Forty-two per cent were receiving opioid substitution therapy
Twelve-week post-treatment follow-up showed that 93% of
those who began treatment achieved a sustained virological response (SVR12 or cure).
Two people were lost to follow-up, two discontinued treatment prematurely,
one died and one person was reinfected. There were no cases of virologic
rebound after treatment. All eight people who continued to report injecting
drug use during the treatment period achieved a sustained virological response.