Real-World Prospective Cohort Study of Treatment and Reinfection of Hepatitis C in a Needle and Syringe Exchange Program in Gothenburg, Sweden: The NEP-C Study.

Author: Pouya Akhiani, Simon Larsson, Johan Westin, Pernilla Lundgren, Rune Wejstål, Magdalena Ydreborg

Theme: Clinical Research Year: 2023

People who inject drugs (PWID) are identified as a key population for Hepatitis C (HCV)-treatment in order to achieve HCV elimination by 2030. Despite this, PWID still have limited access to treatment. In Sweden, the aim of needle and syringe exchange programmes (NEPs) is to prevent the spread of bloodborne viruses such as hepatitis C virus (HCV), and thus treatment for Hepatitis C is offered to participants in the NEPs in order to increase treatment uptake. This study aimed to assess and evaluate effectiveness of HCV-treatment in a PWID-population with a special focus on treatment completion, cure-rates and reinfection.

This is a real-world prospective cohort study, evaluating HCV-treatment among PWID in NEPs between January 2019 and December 2022 in Gothenburg and Trollhättan, Sweden. All individuals with verified HCV-infection aged 18 or above, who had given an informed consent and started treatment were included in the study. Treatment and follow-up were carried out in the NEPs. Study endpoints included treatment initiation and completion, sustained virological response 12 weeks after treatment (SVR-12) and reinfection rates.

113 accepted study inclusion and initiated treatment (75% men, median age 42 years). 90/113 (79.6%) completed treatment. SVR-12 was achieved in 84/113 (74.3%) and 78/82 (95,1%) in intention to treat (ITT) and per protocol analysis respectively. Main reason for not achieving SVR-12 in ITT analysis was lost to follow up (n=17). High age at enrolment was associated with achieving SVR-12 (p= 0.009) and low age at enrolment was associated with lost to follow up (p=0.029). There were five reinfections (incidence 7.3/100 person years). Reinfection was associated with longer follow up time (p=0.026).

This study shows high SVR-rates and DAA effectiveness among PWID despite ongoing injecting drug use. Continued follow-up and testing are needed to find and treat reinfections at an early stage.

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