Theme: Epidemiology & Public Health Research Year: 2016
INCIDENCE AND PREDICTORS OF HEPATITIS C TREATMENT INITIATION AMONG PEOPLE WHO INJECT DRUGS: LONGITUDINAL DATA FROM A GREEK TERTIARY CENTER, 2009-2015.
Papastergiou V1, Anagnostou O1,2, Deutsch M1, Kourikou A1, Zampetas D1, Ionas E1, Kranidioti H1, Kontos G1, Manolakopoulos S1
12nd Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
2Greek Organization against Drugs (OKANA)
Background: People who inject drugs (PWID) account for a large burden of hepatitis C virus (HCV) infection. However, they often face several barriers to accessing antiviral treatment. In the era of highly-efficacious direct-acting antivirals(DAAs), knowledge of factors that prevent treatment among PWID is very crucial.
Methods: We retrospectively reviewed consecutive HCV-viraemic PWID visiting a tertiary liver center (January 2009-June 2015). Patients attending a substitution program were managed by a multidisciplinary approach. Kaplan-Meier and Cox regression analyses were used to evaluate treatment initiation and its correlates.
Results: A total of 177 PWID (141 males, 41.7±10.6 years, 19.7% cirrhotics, 77.9% treatment-naïve) were included: 74(41.8%) former drug users, 88(49.7%) attending substitution programs and 15(8.5%) active users. Treatment was initiated in 101(57.1%), with the vast majority(91.1%) receiving peginterferon/ribavirin(PR). The cumulative probability of treatment was 61.8% over 3 years. During the DAA era treatment was prescribed to 15 out of 35 who visited the center. DAAs were prescribed in 9 patients; only 5 cases in an all-oral regimen. There was no impact of calendar time (2009-11 vs 2012-13 vs 2014-15) on treatment initiation incidence (RR: 1.02, 95%CI: 0.78-1.32; P=0.88). Compared to former drug users, active users were less likely to initiate treatment(RR: 0.17, 95%CI: 0.03-0.91; P=0.04), whereas no difference was observed for patients under substitution (RR: 0.60, 95%CI: 0.30-1.18; P=0.14). ALT<40IU/L(RR: 0.23, 95%CI: 0.09-0.6; P=0.002), genotype 1-4(RR:0.36, 95%CI: 0.17-0.73; P=0.005) and comorbidities that constitute contraindications to interferon(RR: 0.36, 95%CI: 0.19-0.69; P=0.002) were inversely related to treatment initiation. Conclusions: In PWID with HCV infection, active drug use and drawbacks pertinent to PR therapy posed significant barriers to treatment. Few PWIDs had been referred and initiated DAAs during 2014-15. In the era of financial crisis delineating the barriers to initiate DDAs should urgently be explored in order to reduce the burden of the disease in this population.
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