Direct acting antivirals (DAAs) have revolutionized the treatment of chronic hepatitis C (HCV) infection. Data are only beginning to emerge regarding outcomes among patients receiving opioid agonist treatment (OAT) who are also treated for HCV with DAAs. This study compared sustained virologic response (SVR) rates and proportions of lost to follow-up (LTFU) between patients treated with OAT compared with patients not treated with OAT (prior or no drug use history) in the German Hepatitis C-Registry. Of 7747 patients with chronic HCV infection who initiated DAA therapy, 739 were treated with OAT and 7008 were not treated with OAT; 528 patients treated with OAT and 5582 not treated with OAT completed antiviral therapy and had at least one follow-up documentation.
- In an intent-to-treat analysis (all patients regardless of whether they engaged in the assigned intervention), 85% of patients treated with OAT and 86% of patients with OUD not treated with OAT achieved SVR; 92% of patients without OUD achieved SVR. However, per protocol analyses (which included patients who completed follow-up and were adherent to the treatment) found that SVR rates were ≥94% in all groups.
- Predictors of SVR included genotype (non-genotype 3), non-cirrhotic liver morphology, female sex, and normal platelet count.
- In the OAT group, the proportion of LTFU was higher (10%) than the group of patients with OUD who were not treated with OAT (9%) and the group of patients without OUD (3%). The OAT group consisted of more males, was younger, and had higher proportion of genotype 3 infection.
Comments: Although intent-to-treat analyses revealed patients with OUD had lower rates of SVR than patients without OUD, they also had a higher prevalence of unfavorable prognostic factors and LTFU. Per protocol analysis revealed similar high rates of SVR among all groups. These findings suggests that OUD should not be considered a contraindication to treatment.
Jeanette M. Tetrault, MD
Reference: Christensen S, Buggisch P, Mauss S, et al. Direct-acting antiviral treatment of chronic HCV-infected patients on opioid substitution therapy: Still a concern in clinical practice? Addiction. 2018;113(5):868–882.