High hepatitis C cure rate in Thai study of community-based treatment

Keith Alcorn
Published:
09 August 2021
Wiraporn Srisuwanwattana, USAID. Creative Commons licence.

Community-based testing and treatment for HIV and hepatitis C achieved high hepatitis C cure rates in Thailand, results from the Thai C-FREE study show.

Tanyapom Wansom presented results from the C-FREE cohort study of community-based HIV and hepatitis C testing and treatment in Thailand, at the International AIDS Society Conference on HIV Science last month.

The C-FREE study was designed to evaluate the uptake of HIV and viral hepatitis testing and treatment in people who use drugs and their sexual partners in Thailand. Testing and treatment were delivered in community settings offering harm reduction services in four cities in Thailand. The model of care is designed to eliminate barriers to treatment and provide services in settings that people who use drugs feel comfortable to visit.

Glossary

decompensated cirrhosis

The later stage of cirrhosis, during which the liver cannot perform some vital functions and complications occur. See also ‘cirrhosis’ and ‘compensated cirrhosis’.

intent to treat analysis

All participants in a clinical trial are included in the final analysis, in the groups they were originally assigned to, whether or not they actually completed their course of treatment. Provides a better estimate of the real world effect of a treatment than an ‘on treatment analysis’.

  • Partner organisations disseminated information in the community about the opportunity to be treated for hepatitis C to people who inject drugs.
  • Counselling and testing for HIV and hepatitis B and C were provided at a local harm reduction drop-in.
  • People with chronic hepatitis C were referred for treatment.
  • 12 weeks after completion of treatment, a research nurse confirms cure of hepatitis C by doing a rapid viral load test at the harm reduction drop-in centre.

C-FREE is a prospective cohort study that offers testing for HIV, hepatitis B and hepatitis C every three months. An open-label treatment study provides 12 weeks of treatment with the pangenotypic regimen of generic sofosbuvir/velpatasvir for anyone diagnosed with hepatitis C apart from people with decompensated cirrhosis or liver cancer.

The C-FREE cohort has enrolled 1322 people since May 2019, mainly referred by community outreach. Cohort members have a median age of 44 years, 85% are male and 12.5% are gay or bisexual men. Thirty-five per cent are currently injecting drugs and 38% have injected drugs in the past.

Almost 40% of the study cohort are living with HIV, most diagnosed prior to joining the cohort, and 94% of people with HIV are on antiretroviral treatment. Seventy-five per cent of people with HIV have fully suppressed viral load.

Five per cent were diagnosed with chronic hepatitis B and 68% tested positive for hepatitis C antibodies, of which 83% had chronic hepatitis C. Nine per cent had cirrhosis. Seventy-one per cent of people with HIV were co-infected with hepatitis C, while 2% were co-infected with HIV and hepatitis B.

The hepatitis C treatment sub-study enrolled 667 people, of whom ten died or were lost to follow-up before completing treatment and follow-up testing. Of the 667 people who started treatment, 549 completed treatment, 445 were evaluated for sustained virologic response and 424 achieved a sustained virologic response. As the study is ongoing, not all participants have completed treatment. Intent to treat analysis, counting all those who have completed treatment, shows a cure rate of 92.7%.

Hepatitis C treatment was well tolerated with no serious adverse events related to the study treatment.

Reference

Wansom T et al. High HCV cure rates in C-FREE, first community-based study offering testing and treatment of viral hepatitis and HIV among people who use drugs and their partners in Thailand. Eleventh International AIDS Society Conference on HIV Science, abstract OAB0103, 2021.

Image: Wiraporn Srisuwanwattana, USAID. Available at www.flickr.com/photos/usaidasia/27234729458/ under a Creative Commons licence CC BY-NC 2.0.