Theme: Clinical Research Year: 2017
Background:
More than 85% of hepatitis C virus (HCV) diagnoses in Scotland are in people who inject drugs (PWIDs). Although those still actively injecting represent the group most severely affected they are the least likely to receive treatment as they can be deemed too chaotic to treat. However if “treatment as prevention” (TasP) is to work active PWIDs must be treated.
Methods:
To recruit and treat 100 PWIDs over a five-year period, who are HCV positive and actively injecting.
Genotype 1 (GT1) were treated with a protease inhibitor (Telaprevir or Simeprevir) plus PEG-Interferon and Ribavirin. Genotype 2 and Genotype 3 were treated with PEG-Interferon/Ribavirin.
Weekly support offered for compliance and drug safety monitoring.
Results:
A total of 105 patients were recruited in 42 months. 72% were male, and of these 94 patients went onto receive treatment. Of these 94 patients 40.4% were GT1, 1.1% GT2 and 58.5% GT3. 11 patients did not commence treatment as 3 spontaneously resolved, 4 were lost to follow-up. 3 were treated on standard pathway as they became drug free and 1 died prior to commencing treatment.
Of the 94 patients who received treatment, 90 SVR12 results are available. 76/90 (84.4%) have achieved SVR. 32/38 GT1 achieved SVR whilst 44/52 (84.6%) GT2 & 3 achieved SVR.
Of the 14 who did not achieve SVR12, 14 relapsed on treatment (only 4 of these patients completed the entire treatment, 7 completed less than half of the allotted treatment) and 1 became re-infected with a different genotype.
The rate of re-infection was 1 per 9 patient years.
Conclusion:
Active PWIDs can be successfully cured of HCV, even with DAA/ Pegylated Interferon and Ribavirin treatment regimes.
The re-infection rate is compatible with a TasP strategy.