HCV care in an opiate substitution therapy program: assessment of infection, liver-related damage, and treatment rates.
Introduction: treatment of hepatitis C virus (HCV) infection is recommended in patients being treated with methadone or buprenorphine. We aimed to assess HCV screening, liver-related damage, and treatment rates of HCV in patients enrolled in an opioid substitution therapy (OST) program.
Methods: cross-sectional study between October 2015 and September 2017. Socio-demographic and substance use characteristics, HCV status (anti-HCV, HCV-RNA, genotype), indirect markers of liver fibrosis (FIB-4, APRI, Forns), and HIV co-infection were analyzed during the study period. Medical records were used to ascertain treatment of HCV (year of initiation, duration, type and outcome). Logistic regression models were used to analyze predictors of treatment with direct-acting antiviral (DAA) agents.
Results: 501 patients (81.4% M) admitted, median age of 45 years (interquartile range [IQR] 39–50 years); 64.6% had history of injection drug use, 67% were anti-HCV positive and 34% were HCV/HIV co-infected. In anti-HCV-positive patients, prevalence of alcohol, cannabis, and cocaine use were 47%, 39%, and 29%, respectively. Prevalence of advanced liver fibrosis/cirrhosis by FIB-4, APRI, and Forns was 18%, 19%, and 24%, respectively. Only 91/336 (27.1%) of the anti-HCV positive patients underwent transient elastography (median liver stiffness 9.4 kPa (IQR, 6.1–14.6 kPa)). As of April 30th, 2018, 41.3% (128/310) of the eligible for HCV treatment had received therapy, 70/128 (54.7%) of them with DAAs. In multivariate analysis, HCV/HIV co-infected patients were 2.3 times more likely to be treated (OR=2.3, 95% CI: 1.1–5.0) with respect to HCV-mono-infected patients. In addition, current drug use was a risk factor for not being treated (OR=0.4, 95% CI: 0.2–0.9).
Discussion: Treatment rates continue to be low in both HCV mono-infected and HCV/HIV co-infected, former drug users enrolled in OST. However HIV co-infection may have an impact on the readiness to treat HCV infection.