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Vancouver—providing a broad spectrum of care helps reduce the risk of re-infection after HCV cure

Undiagnosed, untreated or poorly managed mental health conditions can drive some people to substance use. In some cases, substance use can become problematic and can destabilize the lives of users. Some people who share equipment for substance use may become infected with hepatitis C virus (HCV) and HIV. In order to help people begin the process of recovering from problematic substance use and, in some cases, hepatitis C virus—and to help them remain free of HCV re-infection—a range of support services is needed.

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Doctors at the Vancouver Infectious Disease Centre have been caring for people who use substances and who also have viral infections such as HCV and HIV. In the latest report from the centre, a team of healthcare workers reviewed data collected from 148 people who had been using substances for many years. All participants had received treatment with direct-acting antivirals (DAAs) between June 2015 and May 2017 and had been cured.

At the centre, participants received multidisciplinary care to address the following list of issues compiled by the healthcare workers:

  • general medical care
  • psychiatric care
  • addiction-related care
  • social needs

This care was provided before, during and after treatment with DAAs. All participants were substance users.

The average profile of participants upon entering the study was as follows:

  • 79% men, 21% women
  • age – 69 years
  • 66% used heroin and 44% used cocaine (some people used both substances); researchers provided ongoing urine screening to monitor substances used
  • the most common type of HCV infection was genotype 1a, infecting 63% of participants
  • 23% had extensive scarring of the liver
  • 10% were co-infected with HIV

Commonly used DAAs during the study were as follows:

  • Epclusa
  • Harvoni
  • Holkira Pak
  • Zepatier

Results

After an average of 66 weeks of monitoring, no one became re-infected.

The Vancouver team stated that providing relevant health and social services to patients before, during and after HCV treatment helped to decrease the risk of HCV re-infection.

The study was done in an era when overdoses among people who inject drugs have increased in Vancouver (and other parts of North America). These overdoses are increasingly caused by exposure to fentanyl and its analogues. However, no one in the study experienced a fatal overdose. Thus, it is possible that the multidisciplinary care and services provided by the clinic not only helped to prevent re-infection with HCV but also helped to prevent fatal overdoses.

—Sean R. Hosein

REFERENCE:

Alimohammadi A, Thiam A, Holseka J, et al. Recurrent viremia after successful hepatitis C virus therapy with direct-acting antiviral therapy in a cohort of people who use drugs. International Liver Congress, 11-15 April 2018, Paris, France. Poster FRI-405.