Theme: Clinical Research Year: 2016
TREATMENT EVALUATION AND UPTAKE AMONG PERSONS WITH CHRONIC
HEPATITIS C ON OPIUM SUBSTITUTION THERAPY. IS TREATMENT AS
PREVENTION REALISTIC?
Øvrehus ALH1,3
, Birkemose I
2
, Hansen JH1,3 Mössner B
1 , Christensen PC1,3
.
1.Department of Infectious Diseases, Odense University Hospital, Denmark, 2. Odense
Drug Treatment Center, Denmark . 3. Clinical Research Institute, Faculty of Health
Sciences, University of Southern Denmark.
Background: People who inject drugs(PWID) on opium substitution therapy (OST) can be
safely treated for chronic hepatitis C(CHC). The treatment as prevention paradigm(TaP) is
based on the assumption that a substantial proportion of PWID’s can be treated. To
decrease the prevalence of CHC over 10 years from a baseline 40% to 5 % in a setting
where half the PWID population is on OST and a medium needle and syringe program
(NSP) coverage, a minimum of treating 50/1000 PY is warranted. The aim of this study
was to evaluate a population with CHC on OST for treatment in an outreach program.
Feasibility for TaP in our setting was set at treating 10% of persons on OST in one year.
Method: At a drug treatment center(DTC) a cohort of 450 persons on OST of whom 153
fulfilled criteria for CHC (testing uptake 94%) was established in April 2015. Persons under
the age of 50 with no cirrhosis were evaluated for treatment in a (unrelated)clinical trial and
assessed as “treatable” if either treated, or excluded for other reasons than lost to follow
up, significant instability, severe comorbidity, death or incarceration. Remaining patients
were assessed as treatable if present for 2 evaluations in 2 years and/or compliant to
cirrhosis work-up, if in treatment or follow-up after treatment as of April 2015-April 2016.
Results: In the CHC cohort median age was 43(26-66), 75% male and 15% had a
Transistient Elastometry>12 kpa. Of 153 patients, 84 (55%) were treated(43)/treatable(41).
Fifty-nine persons were assessed as non-treatable. Main reasons being instability and lost
to follow up
Conclusion: The number of both treated and treatable patients by far exceeded the
number models require to achieve a substantial reduction in prevalence. There is however
still a substantial number that cannot enter into treatment even in an outreach clinic.