Z Gastroenterol 2019; 57(05): e158
DOI: 10.1055/s-0039-1691923
POSTER
Hepatologie
Georg Thieme Verlag KG Stuttgart · New York

Interim results of an ongoing Project to eliminate chronic hepatitis C in People who inject drugs (PWID) with ongoing intravenous drug use and a high risk of non-adherence to direct-acting antivirals (DAA) in Vienna

C Schmidbauer
1   Wilhelminenspital, Department of Internal Medicine IV, Vienna, Austria
2   Medical University of Vienna, Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Vienna, Austria
3   Vienna HIV & Liver Study Group, Vienna, Austria
,
A Schütz
4   Suchthilfe Wien gGmbH, Ambulatorium Suchthilfe Wien, Vienna, Austria
,
C Schwanke
4   Suchthilfe Wien gGmbH, Ambulatorium Suchthilfe Wien, Vienna, Austria
,
R Schubert
4   Suchthilfe Wien gGmbH, Ambulatorium Suchthilfe Wien, Vienna, Austria
,
J Luhn
4   Suchthilfe Wien gGmbH, Ambulatorium Suchthilfe Wien, Vienna, Austria
,
E Gutic
1   Wilhelminenspital, Department of Internal Medicine IV, Vienna, Austria
,
R Pirker
1   Wilhelminenspital, Department of Internal Medicine IV, Vienna, Austria
,
T Lang
1   Wilhelminenspital, Department of Internal Medicine IV, Vienna, Austria
,
H Haltmayer
4   Suchthilfe Wien gGmbH, Ambulatorium Suchthilfe Wien, Vienna, Austria
,
M Gschwantler
1   Wilhelminenspital, Department of Internal Medicine IV, Vienna, Austria
› Institutsangaben
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
16. Mai 2019 (online)

Auch verfügbar auf
 

Background and Aims:

A subgroup of people who inject drugs (PWID) receiving opioid agonist therapy (OAT) cannot be treated at hepatological centers and would not regularly ingest their medication based on self-administration. In these patients, chronic hepatitis C might ideally be managed at low-threshold facilities and if direct-acting antivirals (DAA) were administered together with OAT under direct observation of medical staff.

Method:

300 PWID on stable OAT with chronic hepatitis C and high risk for non-adherence to DAA-therapy (male/female: 228/72; mean age: 38.0 ± 8.3 years; genotype (GT) 1/2/3/4: 178/3/109/7 (unknown: n = 3); HIV-coinfection: n = 18; liver cirrhosis: n = 60) started antiviral treatment. Patients received antiviral therapy together with OAT under direct observation of a pharmacist, physician or nurse at a pharmacy or low-threshold facility. The DAA-regimen was selected according to GT, fibrosis stage, pretreatment and current reimbursement policy of insurances.

Results:

Following this concept, adherence to therapy was excellent: Only 0.15% of scheduled dates for ingestion of the antiviral therapy in combination with OAT were missed by the 300 patients. Till now, 214 patients have completed treatment and a 12-week follow-up period. Virological cure of hepatitis C infection (sustained virologic response, SVR12) could be confirmed in 213/214 patients (SVR12 rate: 99.5%; 95% CI: 97.3 – 99.9). One patient died 8 weeks after end of therapy for reasons not related to treatment. During follow-up, reinfections occured in 12/214 (5.6%) patients. The cumulative rate of reinfection 24 and 48 weeks after end of therapy was 5.3% and 9.5%, respectively.

Conclusion:

Directly observed therapy of chronic hepatitis C at a pharmacy or a low-threshold facility is highly effective in PWID with ongoing intravenous drug use and a high risk for non-adherence to DAA. By this concept, a group of difficult-to-treat patients can be cured, who could not have been treated in settings of studies published so far.