Hepatitis C virus burden: Treating and educating people without prejudice

Area of Science:

• Hepatology
• Infectious Diseases
• Addiction Medicine

Background:

• Hepatitis C virus (HCV) infection affects 1.1% globally, with 60% of individuals receiving substance use disorder (SUD) treatment in Italy being HCV-positive.
• People who inject drugs (PWIDs) face significant barriers to HCV care, including co-occurring alcohol abuse, psychiatric conditions, and homelessness.
• Limited access to care for HCV-infected PWIDs necessitates specialized service models.

Purpose of the Study:

• To evaluate the impact of a dedicated HCV service for substance use disorder (SSUD) on PWIDs undergoing anti-HCV therapy.
• To assess the efficacy of a multidisciplinary team approach in treating HCV in a population with active or past substance abuse.

Main Methods:

• A multidisciplinary team established an HCV-dedicated service at the SSUD of Trento in October 2020.
• HCV RNA-positive patients with a history of substance abuse received Direct-Acting Antivirals (DAAs) and a health education program.
• Retrospective analysis assessed therapy completion, HCV eradication, compliance, reinfection rates, and DAA-related toxicity.

Main Results:

• All 40 enrolled patients completed HCV therapy, with 92.5% adherence to the program.
• Sustained virological response (SVR) was achieved in 92.5% of patients, with no significant drug interactions or observed side effects.
• One case of HCV reinfection and two patient deaths (overdose, cirrhosis complications) occurred post-eradication.

Conclusions:

• The dedicated SSUD service demonstrated very high adherence and good tolerability for HCV treatment in patients with substance abuse issues.
• The multidisciplinary approach facilitates effective HCV eradication in PWIDs, irrespective of their substance abuse status.
• Further validation in larger populations is recommended to confirm these findings.