HCV Treatment Among Fentanyl Users: Towards Universal Access to Antiviral Therapy

Author: Brian Conway David Truong Leo Yamamoto Shawn Sharma Rossitta Yung Ginny Liu

Theme: Epidemiology & Public Health Research Year: 2022

To achieve HCV elimination among all infected populations by 2030, specific programs will need to
be designed for individuals who are difficult to engage and maintain in care. This includes active
opiate agonist fentanyl users, associated with a higher risk of overdose events(including deaths),
quite often in the context of social and medical instability. We evaluated the success rate of HCV
therapy among active fentanyl users identified through our inner-city outreach program and
receiving treatment within our innovative model of multidisciplinary care.
Patients were included in this analysis if active street fentanyl use was identified at the time of HCV
therapy initiation at our centre. HCV therapy was administered within the context of
multidisciplinary care. Medication adherence was verified on weekly basis, with frequent/daily
administration in concert with opiate agonist therapy being implemented as appropriate. The
primary endpoint was achievement of cure of HCV infection(as measured by SVR 12), with
documentation of treatment and patient-related correlates of therapeutic failure. Significant health
outcomes were also recorded.
We identified 208 eligible subjects (149(71.6%)male, 41(19.7%)Aboriginal, 15(7.2%)cirrhotic)
initiating HCV treatment between March2019 and May2022. All had historical fentanyl use in the
previous week or positive urine drug screen at HCV treatment initiation with either
sofosbuvir/velpatasvir(S/V,133) or glecaprevir/pibrentasvir(G/P,75). Premature discontinuation was
recorded in 11 cases (1 deceased, 3 withdrawn, 7 non-adherence/LTFU). 147 participants have now
completed therapy, 22 of them are awaiting for post-treatment HCV RNA result. SVR12 and/or 24
was documented in 110/114 (96.5%) on S/V, and 67/68 (98.5%) on G/P. Reasons for therapeutic
failure were all relapse(4/114 on S/V, 1/68 on G/P). There were 2 overdose deaths, with no
difference in rate between S/V and G/P.
Delivered within the program we have developed, HCV therapy is highly effective among active
fentanyl users, with no difference in safety or efficacy between S/V and G/P.
Disclosure of Interest Statement:
Dr. Conway has received grant support, honoraria and acted as a remunerated advisor for AbbVie
Corporation, Gilead Sciences Inc., Indivior Canada Ltd., Merck & Co., Moderna, Sanofi Pasteur, and
ViiV Healthcare. No pharmaceutical grants were received in the development of this study.

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