Theme: Clinical Research Year: 2018
Background:
If elimination goals for hepatitis C virus (HCV) infection are to be achieved, people who inject
drugs (PWID) need to be the focus of treatment scale-up. The TraP HepC program in
Iceland aims for elimination of chronic HCV infection by targeting those most likely to
transmit. Vogur Addiction Hospital, a key sentinel site where >90% of PWIDs seek treatment
for their addiction provides an opportunity to monitor early trends in HCV prevalence in this
population.
Methods:
All patients with HCV in Iceland have been offered direct acting antiviral agents (DAA)
treatment since 01/2016. Relapses and reinfections are promptly treated. PWID admitted at
Vogur Addiction Hospital are screened for HCV. We compared the prevalence of HCV
viremia among PWID at Vogur Hospital prior to initiation of and following the 2nd year of TraP
HepC.
Results:
During the first 24 months 632 patients, 80% of the estimated total patient population, were
initiated on DAAs. Recent (within 6 months) IDU was reported by 34%. Stimulants were the
preferred IV drug in 86%, opioids in 14% (9% on opioid substitution therapy). Of those who
completed treatment, sustained virological response at 12 weeks (SVR 12) was 96%. Of
those who discontinued HCV treatment (8.2%) many still achieved SVR12 (40%) and and
most of the remaining were re-treated. The prevalence of HCV viremia among recently
injecting PWID admitted for addiction treatment was on average 47.9% (2012-2015),
dropping to 16.2% in 2017 (66% reduction, p<0.001) . Likewise, the prevalence of viremia
among patients with history of IDU but not recently injecting fell from 27.4% (2012-2015) to
4.1% in 2017 (85% reduction, p<0.001).
Conclusion:
The TrapHepC program has resulted in an early and marked reduction in prevalence of HCV
among PWID. These results indicate that treatment as prevention may be a successful
approach in the prevention of transmission of HCV among PWID.