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Strong evidence supports removal of restrictions to direct-acting antiviral therapy based on recent drug use.
People who use or inject drugs and those who receive opioid substitution therapy respond favorably to direct-acting antiviral (DAA) therapy, according to a new study.
The leaders of the study call for an end to discriminatory health and illicit drugs policies based on overwhelming evidence that new hepatitis C virus (HCV) therapies cure the vast majority of people who inject drugs.
More than one in three people worldwide who have injected drugs in the past year are living with HCV. New DAA therapies for HCV can cure the virus in more than 95 percent of people. However, in many countries DAA treatment is inaccessible to those who inject drugs due to restrictions on treatment reimbursement related to recent drug use. In addition, many clinicians are hesitant to prescribe HCV therapy to people who use or inject drugs because of concerns about adherence and the chance of reinfection.
“People should not be denied life-saving treatments simply because of their recent drug use,” said senior author Jason Grebely, Associate Professor at the Kirby Institute and also President of the International Network of Hepatitis in Substance Users. “Policies that deny hepatitis C treatment for people who use or inject drugs are unacceptable; they are driven by discrimination as opposed to evidence. I hope our research will encourage countries to overturn these policies and allow treatment to all people living with hepatitis C, regardless of current or previous drug use. In fact, given high prevalence rates, people who inject drugs really should be prioritized for treatment.”
The researchers published their results in November 2018 in The Lancet Gastroenterology & Hepatology.
Grebely and colleagues searched bibliographic databases and conference presentations for observational studies and clinical trials assessing DAA treatment completion, sustained virological response (SVR), and loss to follow-up among people with recent drug use, both injecting or non-injecting, and those receiving opioid substitution therapy.
The study included 38 eligible studies with 3634 participants. The definition of recent drug use varied across studies, with drug use in the past 6 months and at the initiation of or during DAA therapy most commonly used.
In 21 studies and 1408 participants of those with recent injecting or non-injecting drug use, treatment completion was 97.5 percent and SVR was 87.7 percent. In 36 studies and 2987 participants among individuals receiving opioid substitution therapy, treatment completion was 97.4% and SVR was 90.7 percent. In 8 studies of 670 participants who recently injected drugs, treatment completion was 96.9 percent and SVR was 87.4 percent.
In a meta-regression analysis, clinical trials (versus observational studies) and higher mean or median age were significantly associated with higher SVR. Clinical trials and older age were also significantly associated with a lower proportion of participants lost to follow-up.
“Our data provides robust evidence to inform global clinical guidelines, and we hope it will improve public health policy for hepatitis C treatment for people who use drugs internationally. This will bring us closer to the ambitious goal of global elimination by 2030,” said Grebely.