Swiss Data on Hepatitis C Treatment in People who use Drugs: The SAMMSU Cohort

Author: Erika Castro, Andrea Bregenzer, Philip Bruggmann, Alberto Moriggia, Lorenza Oprandi, Cornelia Staehelin, Madeleine Rothen, Pietro Vernazza and Claude Scheidegger

Theme: Clinical Research Year: 2015

Background: Swiss data concerning hepatitis C treatment in people who use drugs (PWUD) is limited. We therefore launched a retrospective analysis of patients treated for hepatitis C in SAMMSU cohort centers (The Swiss Association for Medical Management in Substance Users).

Patients and Methods:
All patients followed for chronic hepatitis C treatment and opiate substitution therapies between January 2010 to December 2013 were included. We reviewed patients’ laboratory follow-up, liver fibrosis assessment, comorbidities, comedications and drug/alcohol consumption during treatment. Study outcome was sustained virological response (SVR) six months after end of treatment.

Results: We assessed data of all patients treated for chronic hepatitis C (n=129). The median age was 41 years (range: 22-61), 79% were men, 58% had a liver fibrosis score of F3-F4 (n=55/95 recorded) and 63% were under psychiatric medication. Main comorbidities were: chronic alcoholism: 43%, HIV-coinfection: 17% and mental disorders (ICD-10): 71%.
HCV characteristics were: log10 viremia, median (IQR) 5.3 (3.1–7.6), genotype (GT) 3: 53%, GT 1: 36%, GT 4: 8% and GT 2-6: 3%. With regard to treatments regimens, 81% of patients were treated with pegylated interferon + ribavirin alone and 19% of patients harboring GT 1 additionally received a protease inhibitor (8x boceprevir, 15x telaprevir, 1x investigational drug). SVR was reached in 66%. A relapse/breakthrough viremia/nonresponse was seen in 31% and the dropout rate was 3%.

Conclusion: Successful HCV treatment outcome was achieved in 66% of polymorbid PWUD despite ongoing IVDU and daily alcohol drinking in a substantial proportion of them.

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