BACKGROUND: Intravenous drug use (IVDU) represents the major factor of HCV transmission, but the treatment uptake among people who inject drugs (PWID) remains low owing to a false presumption of low efficacy. The aim of our study was to assess treatment efficacy in PWID and factors determining adherence to therapy. METHODS: A total of 278 consecutive patients starting DAA (direct-acting antivirals) therapy were included, divided into two groups: individuals with a history of IVDU, PWID group (N = 101) and the control group (N = 177) without a history of IVDU. RESULTS: Sustained virological response 12 weeks after the end of therapy (SVR12) was achieved by 99/101 (98%) and 172/177 (98%) patients in the PWID and control group, respectively; in PWID group, two patients were lost to follow-up, and in the control group, four patients relapsed and one was lost to follow-up. PWID patients postponed appointments significantly more often, 29 (28.7%) in PWID versus 7 (4%) in the control group, p = 0.001. Thirteen of 101 (12.9%) and six of 177 (3.4%) patients in the PWID and in the control group, respectively, missed at least one visit (p < 0.01). However, postponing visits led to a lack of medication in only one PWID. In the PWID group, older age (p < 0.05; OR 1.07, 95% CI 1.00-1.20) and stable housing (p < 0.01; OR 9.70, 95% CI 2.10-56.20) were factors positively contributing to adherence. Contrarily, a stable job was a factor negatively influencing adherence (p < 0.05; OR 0.24, 95% CI 0.06-0.81). In the control group, none of the analyzed social and demographic factors had an impact on adherence to therapy. CONCLUSIONS: In PWID, treatment efficacy was excellent and was comparable with SVR of the control group. Stable housing and older age contributed to a better adherence to therapy.

1st Faculty of Medicine Charles University Prague Czech Republic

Addiction Centre Prague Prague Czech Republic

Cardiothoracic Anaesthesiology and Intensive Care Department of Anaesthesiology and Intensive Care Medicine Institute for Clinical and Experimental Medicine Prague Czech Republic

Department of Hepatogastroenterology Institute for Clinical and Experimental Medicine Videnska 1958 9 14021 Prague Czech Republic

Institute of Medical Biochemistry and Laboratory Diagnostics 1st Faculty of Medicine Charles University and General University Hospital Prague Prague Czech Republic

Psychiatric Hospital Havlickuv Brod Havlickuv Brod Czech Republic

See more in PubMed

Degenhardt L, Peacock A, Colledge S, Leung J, Grebely J, Vickerman P, Stone J, Cunningham EB, Trickey A, Dumchev K, et al. Global prevalence of injecting drug use and sociodemographic characteristics and prevalence of HIV, HBV, and HCV in people who inject drugs: a multistage systematic review. Lancet Glob Health. 2017;5(12):e1192–e1207. doi: 10.1016/S2214-109X(17)30375-3. PubMed DOI PMC

EASL EASL recommendations on treatment of hepatitis C 2018. J Hepatol. 2018;69:461–511. doi: 10.1016/j.jhep.2018.03.026. PubMed DOI

Grebely J, Robaeys G, Bruggmann P, Aghemo A, Backmund M, Bruneau J, Byrne J, Dalgard O, Feld JJ, Hellard M, et al. Recommendations for the management of hepatitis C virus infection among people who inject drugs. Int J Drug Policy. 2015;26(10):1028–1038. doi: 10.1016/j.drugpo.2015.07.005. PubMed DOI PMC

Frankova S, Urbanek P, Husa P, Nemecek V, Razavi H, Razavi-Shearer D, Chlibek R, Sperl J. Chronic hepatitis C in the Czech Republic: forecasting the disease burden. Cent Eur J Public Health. 2019;27(2):93–98. doi: 10.21101/cejph.a5350. PubMed DOI

Edlin BR. Perspective: test and treat this silent killer. Nature. 2011;474(7350):S18–19. doi: 10.1038/474S18a. PubMed DOI PMC

Nelson PK, Mathers BM, Cowie B, Hagan H, Des Jarlais D, Horyniak D, Degenhardt L. Global epidemiology of hepatitis B and hepatitis C in people who inject drugs: results of systematic reviews. Lancet. 2011;378(9791):571–583. doi: 10.1016/S0140-6736(11)61097-0. PubMed DOI PMC

Chlibek R, Smetana J, Sosovickova R, Gal P, Dite P, Stepanova V, Pliskova L, Plisek S. Prevalence of hepatitis C virus in adult population in the Czech Republic—time for birth cohort screening. PLoS ONE. 2017;12(4):e0175525. doi: 10.1371/journal.pone.0175525. PubMed DOI PMC

https://www.drogy-info.cz/data/obj_files/32962/837/VZdrogy2017_web181207.pdf.

Powell DW, Abramson BZ, Balint JA, Belle S, Bloomer JR, Diehl AK, Frakes JT, Garcia-Tsao G, Hook EW, Lusher JM, Popovsky MA. National Institutes of Health Consensus Development Conference Panel statement: management of hepatitis C. Hepatology. 1997;26(3 Suppl 1):2S–10S. PubMed

Mehta SH, Genberg BL, Astemborski J, Kavasery R, Kirk GD, Vlahov D, Strathdee SA, Thomas DL. Limited uptake of hepatitis C treatment among injection drug users. J Community Health. 2008;33(3):126–133. doi: 10.1007/s10900-007-9083-3. PubMed DOI PMC

Iversen J, Grebely J, Catlett B, Cunningham P, Dore GJ, Maher L. Estimating the cascade of hepatitis C testing, care and treatment among people who inject drugs in Australia. Int J Drug Policy. 2017;47:77–85. doi: 10.1016/j.drugpo.2017.05.022. PubMed DOI

Socias ME, Ti L, Wood E, Nosova E, Hull M, Hayashi K, Debeck K, Milloy MJ. Disparities in uptake of direct-acting antiviral therapy for hepatitis C among people who inject drugs in a Canadian setting. Liver Int. 2019;39(8):1400–1407. doi: 10.1111/liv.14043. PubMed DOI PMC

Tsui JI, Miller CM, Scott JD, Corcorran MA, Dombrowski JC, Glick SN. Hepatitis C continuum of care and utilization of healthcare and harm reduction services among persons who inject drugs in Seattle. Drug Alcohol Depend. 2019;195:114–120. doi: 10.1016/j.drugalcdep.2018.11.026. PubMed DOI PMC

Bruggmann P, Litwin AH. Models of care for the management of hepatitis C virus among people who inject drugs: one size does not fit all. Clin Infect Dis. 2013;57(Suppl 2):S56–61. doi: 10.1093/cid/cit271. PubMed DOI PMC

Dore GJ, Altice F, Litwin AH, Dalgard O, Gane EJ, Shibolet O, Luetkemeyer A, Nahass R, Peng CY, Conway B, et al. Elbasvir–Grazoprevir to treat hepatitis C virus infection in persons receiving opioid agonist therapy: a randomized trial. Ann Intern Med. 2016;165(9):625–634. doi: 10.7326/M16-0816. PubMed DOI

Grebely J, Dalgard O, Conway B, Cunningham EB, Bruggmann P, Hajarizadeh B, Amin J, Bruneau J, Hellard M, Litwin AH, et al. Sofosbuvir and velpatasvir for hepatitis C virus infection in people with recent injection drug use (SIMPLIFY): an open-label, single-arm, phase 4, multicentre trial. Lancet Gastroenterol Hepatol. 2018;3(3):153–161. doi: 10.1016/S2468-1253(17)30404-1. PubMed DOI

Kattakuzhy S, Mathur P, Gross C, Silk R, Hil K, Nussdorf L, Chaudhury CS, Sternberg D, Masur H, Kottilil S, et al. High SVR in PWID with HCV despite imperfect medication adherence: data from the anchor study. Hepatology. 2018;68(S1):1–183. doi: 10.1002/hep.30256. DOI

EASL EASL clinical practice guidelines: management of alcohol-related liver disease. J Hepatol. 2018;69:154–181. doi: 10.1016/j.jhep.2018.03.018. PubMed DOI

Falade-Nwulia O, Irvin R, Merkow A, Sulkowski M, Niculescu A, Olsen Y, Stoller K, Thomas DL, Latkin C, Mehta SH. Barriers and facilitators of hepatitis C treatment uptake among people who inject drugs enrolled in opioid treatment programs in Baltimore. J Subst Abuse Treat. 2019;100:45–51. doi: 10.1016/j.jsat.2019.01.021. PubMed DOI PMC

Phillips C, Schulkind J, O'Sullivan M, Edelman N, Smith HE, Verma S, Jones CJ. Improving access to care for people who inject drugs: qualitative evaluation of project ITTREAT—an integrated community hepatitis C service. J Viral Hepat. 2019;27:176–187. doi: 10.1111/jvh.13214. PubMed DOI

Olafsson S, Tyrfingsson T, Runarsdottir V, Bergmann OM, Hansdottir I, Bjornsson ES, Johannsson B, Sigurdardottir B, Fridriksdottir RH, Love A, et al. Treatment as Prevention for Hepatitis C (TraP Hep C)—a nationwide elimination programme in Iceland using direct-acting antiviral agents. J Intern Med. 2018;283(5):500–507. doi: 10.1111/joim.12740. PubMed DOI

Feld JJ, Jacobson IM, Hezode C, Asselah T, Ruane PJ, Gruener N, Abergel A, Mangia A, Lai CL, Chan HL, et al. Sofosbuvir and velpatasvir for HCV genotype 1, 2, 4, 5, and 6 infection. N Engl J Med. 2015;373(27):2599–2607. doi: 10.1056/NEJMoa1512610. PubMed DOI

Forns X, Lee SS, Valdes J, Lens S, Ghalib R, Aguilar H, Felizarta F, Hassanein T, Hinrichsen H, Rincon D, et al. Glecaprevir plus pibrentasvir for chronic hepatitis C virus genotype 1, 2, 4, 5, or 6 infection in adults with compensated cirrhosis (EXPEDITION-1): a single-arm, open-label, multicentre phase 3 trial. Lancet Infect Dis. 2017;17:1062–1068. doi: 10.1016/S1473-3099(17)30496-6. PubMed DOI

Foster GR, Afdhal N, Roberts SK, Brau N, Gane EJ, Pianko S, Lawitz E, Thompson A, Shiffman ML, Cooper C, et al. Sofosbuvir and velpatasvir for HCV genotype 2 and 3 infection. N Engl J Med. 2015;373(27):2608–2617. doi: 10.1056/NEJMoa1512612. PubMed DOI

Kowdley KV, Gordon SC, Reddy KR, Rossaro L, Bernstein DE, Lawitz E, Shiffman ML, Schiff E, Ghalib R, Ryan M, et al. Ledipasvir and sofosbuvir for 8 or 12 weeks for chronic HCV without cirrhosis. N Engl J Med. 2014;370(20):1879–1888. doi: 10.1056/NEJMoa1402355. PubMed DOI

Kwo PY, Poordad F, Asatryan A, Wang S, Wyles DL, Hassanein T, Felizarta F, Sulkowski MS, Gane E, Maliakkal B, et al. Glecaprevir and pibrentasvir yield high response rates in patients with HCV genotype 1–6 without cirrhosis. J Hepatol. 2017;67(2):263–271. doi: 10.1016/j.jhep.2017.03.039. PubMed DOI

D'Ambrosio R, Pasulo L, Puoti M, Vinci M, Schiavini M, Lazzaroni S, Soria A, Gatti F, Menzaghi B, Aghemo A, et al. Real-world effectiveness and safety of glecaprevir/pibrentasvir in 723 patients with chronic hepatitis C. J Hepatol. 2019;70(3):379–387. doi: 10.1016/j.jhep.2018.11.011. PubMed DOI

Berg T, Naumann U, Stoehr A, Sick C, John C, Teuber G, Schiffelholz W, Mauss S, Lohmann K, Konig B, et al. Real-world effectiveness and safety of glecaprevir/pibrentasvir for the treatment of chronic hepatitis C infection: data from the German Hepatitis C-Registry. Aliment Pharmacol Ther. 2019;49(8):1052–1059. doi: 10.1111/apt.15222. PubMed DOI

Skoupá J, Urbánek P. A comparison of cost-effectiveness analysis of two strategies—immediate and delayed initiation of treatment of hepatitis C in the Czech Republic. Gastroenterol Hepatol. 2018;72(1):58–65. doi: 10.14735/amgh201858. DOI

Sperl J, Frankova S, Kreidlova M, Merta D, Tothova M, Spicak J. Combination of sofosbuvir and daclatasvir in the treatment of genotype 3 chronic hepatitis C virus infection in patients on maintenance hemodialysis. Ther Clin Risk Manag. 2017;13:733–738. doi: 10.2147/TCRM.S133983. PubMed DOI PMC

Sperl J, Kreidlova M, Merta D, Chmelova K, Senkerikova R, Frankova S. Paritaprevir/ritonavir/ombitasvir plus dasabuvir regimen in the treatment of genotype 1 chronic hepatitis C infection in patients with severe renal impairment and end-stage renal disease: a real-life cohort. Kidney Blood Press Res. 2018;43(2):594–605. doi: 10.1159/000488965. PubMed DOI

Urbanek P, Frankova S, Husa P, Sperl J, Plisek S, Roznovsky L, Kumpel P. Standard diagnostic and therapeutic approach to chronic hepatitis C virus (HCV) infection—guidelines. Gastroenterol Hepatol. 2019;73(2):101–125. doi: 10.14735/amgh2019101. PubMed DOI

Predictors of Significant Liver Fibrosis in People with Chronic Hepatitis C Who Inject Drugs in the Czech Republic

HCV Elimination in Central Europe with Particular Emphasis on Microelimination in Prisons