Treatment with direct-acting antiviral agents of hepatitis C virus infection in injecting drug users: a prospective study

In this prospective study, we evaluated the effectiveness and tolerability of novel therapies against hepatitis C virus (HCV) in a cohort of PWID enrolled at our centre from April 2015 to July 2016. In this analysis, a total of 174 patients were included: 11 (6.3%) were treated with pegylated-interferon (PEG-IFN) and ribavirin (RBV) containing regimens, 163 (93.7%) with IFN-free treatments. RBV has been used in 70 patients (40.2%); 59 (33.9%) patients were in opioid substitution therapy (OST) with methadone or buprenorphine. Overall, sustained virological response (SVR) has been observed in 162 subject (93.1%), breakthrough (BT) in 3 (1.7%), relapse in 1 (0.6%), drop-out in 8 (4.6%). Treatment was interrupted for clinical conditions in 7 patients: 6 (3.4%) had hepatic decompensation and 1 died for hepatocellular carcinoma (HCC). In multivariate analysis, predictive factors of treatment failure were: albumin level below 3 g/dL (OR=7.190; 95%IC=1.236-41.837; p<0.001), MELD score >10 (OR=5.886; 95%IC=1.411-35.994; p<0.001) and years of HCV infection >20 (OR=1.286; 95%IC=0.556-9.455; p=0.016). In conclusion, treatment with DAAs was effective and well tolerated in PWID; cirrhotic subjects with MELD >10 and albumin low level showed a higher risk of developing serious adverse events and treatment failure. This article is protected by copyright. All rights reserved.