ABSTRACT # 871: HCV Reinfection and Injecting Risk Behavior Following Elbasvir/Grazoprevir Treatment in Patients on Opioid Agonist Therapy: Co-STAR Part B – Three Year Follow-up Study—G. Dore, at al.
The Co-STAR study is an on-going study that included patients who were on opioid agonist therapy (OAT) for at least three months to treat addiction before entering the study. There were 301 patients (genotypes 1, 4 and 6). Part A found that the overall cure rates were 91%.
This report is on Part B: a 3-year observational follow-up study to look at the re-infection rate. There were 199 participants enrolled in the follow-up phase. Every six months the participants were given drug urine screen, an HCV RNA (viral load test) to check for reinfection and a questionnaire to self-report drug use.
Conclusions: There was drug use during the follow-up period. However, of the 199 patients enrolled in the 3-year follow-up, there were ten people who were re-infected. Interestingly, of the ten people who had become re-infected three people had resolved the acute infection and two people had been re-treated. No information was given if the two people who were re-treated had achieved a cure.
Editorial Comments: These are excellent results. Personally, I am thrilled with the outcome of the trial. I think this study demonstrates that treating people with addictions can produce high cure rates and low reinfection rates.
Abstract #FRI-234: Efficacy and safety of Epclusa (sofosbuvir plus velpatasvir) in people with chronic hepatitis C virus infection and recent injecting drug use: The SIMPLIFY study—J. Grebely et. al.
Study Aims and Results: The study was an international study to evaluate the safety and effectiveness of sofosbuvir and velpatasvir in people infected with hepatitis C.
The people in the study included HCV Genotypes 1 (35%); 2 (5%); 3 (58%); 4 (2%), age <40yo 24%, female sex 28%, no opioid substitution therapy, but were injecting drugs 32%; opioid substitution and injecting drugs 42%, minimal/early fibrosis (F0-F1) 62% or early/severe fibrosis (F2-F3) 26%, cirrhosis (F-4) 9%.
The study recruited patients from 19 international sites. There were 114 people recruited for the study; 103 who started treatment. Three patients discontinued treatment who were lost to follow-up and there was one death. There was one case of relapse due to reinfection of hepatitis C. The cure rate was 94% (96 of 102 people).
There were very high cure rates and only one reinfection. The people in this trial will be followed for a period of three years.
The clinical trial validates that people who inject drugs who are on or off opioid substitution therapy can be successfully treated with direct-acting antiviral therapy. We need to treat people everyone with hepatitis C including injection drug users.
Abstract # THU-238 Feasibility and acceptability of a group medical visit intervention to improve hepatitis C virus treatment uptake among persons who inject drugs (PWID) in a primary care setting—B. Norton et al. by Matthew Zielske
Study Aims and Results: This study focuses on an inventive intervention called, HCV Group Evaluation and Treatment Uptake (HCV GET-UP).
In this study patients were recruited from a primary care clinic in the Bronx, NY. Group visits with a physician took place over the course of four weeks. During the group visits, hep C related health care evaluations, education support and skill building took place. The likelihood of this study being successful was assessed through recruitment, retention rates and acceptability by means of a short post group survey which was laid out as a 5-point Likert scale (not helpful to very helpful).
Phone contact was made with 27 (67.5%) of the 40 people initially eligible. There were 13 (48.1%) people of those 27 who agreed to be screened with seven deciding to enroll. The demographic breakdown is as follows; most were male, all were African American or Latino and their median age was 55. Almost all of them were being treated for opioids and three of them were actively using drugs at their initial visit.
Conclusion: Of the 6 people that initially attended one group visit, 5 attended a follow up HCV treatment appointment and 4 have begun treatment. The average of the survey results was; evaluation: 5, education: 4.8, skill building: 5, group activity or support: 5
Editorial Comments: A meta-analysis review of acute HCV in people with HIV would be helpful. This will narrow down the optimal timeframe to treat. Still, the cure rates are very encouraging! Although the study is promising in its approach to engaging and retaining hepatitis C positive people who inject drugs in healthcare only 4 of the 40 antibody positive patients began treatment. Of the 7 who enrolled this is a great result but more needs to be done to increase the number of those who willingly begin the process. The fact that three people who were actively using drugs were included is also very promising and shows the healthcare model can and is willing to change.
Editorial Comments: This abstract that provides information about lowering the incidence of hepatitis C among people who inject drugs in Athens, Greece.
Article: Treatment and primary prevention in people who inject drugs for chronic hepatitis C infection: is elimination possible in a high-prevalence setting?—I Gountas et al.
Source: Addiction. 2017 Jan 20. doi: 10.1111/add.13764. [Epub ahead of print]
To project the impact of scaling-up oral anti-viral therapy and harm reduction on chronic hepatitis C (CHC) prevalence and incidence among people who inject drugs (PWID) in Greece, to estimate the relationship between required treatment levels and expansion of harm reduction programmes to achieve specific targets and to examine whether hepatitis C virus (HCV) elimination among PWID is possible in this high-prevalence setting.
A dynamic discrete time, stochastic individual-based model was developed to simulate HCV transmission among PWID incorporating the effect of HCV treatment and harm reduction strategies, and allowing for re-infection following treatment.
The population of 8300 PWID in Athens Metropolitan area.
Reduction in HCV prevalence and incidence in 2030 compared with 2016.
Moderate expansion of HCV treatment (treating 4-8% of PWID/year), with a simultaneous increase of 2%/year in harm reduction coverage (from 44 to 72% coverage over 15 years), was projected to reduce CHC prevalence among PWID in Athens by 46.2-94.8% in 2030, compared with 2016. CHC prevalence would reduce to below 10% within the next 4-5 years if annual HCV treatment numbers were increased up to 16-20% PWID/year. The effect of harm reduction on incidence was more pronounced under lower treatment rates.
Based on theoretical model projections, scaled-up hepatitis C virus treatment and harm reduction interventions could achieve major reductions in hepatitis C virus incidence and prevalence among people who inject drugs in Athens, Greece by 2030. Chronic hepatitis C could be eliminated in the next 4-5 years by increasing treatment to more than 16% of people who inject drugs per year combined with moderate increases in harm reduction coverage.