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Integrated Care for the Use of Direct-acting Antivirals in Patients With Chronic Hepatitis C and Substance Use Disorder

Trabut, Jean-Baptiste, MD; Barrault, Camille, MD; Charlot, Hélène, MPharm; Carmona, Damien, MD; Bourdel, Anne, MD; Benslimane, Mustapha, MD; François, Murielle, RN; Kini-Matondo, Willy, MPharm; Causse, Richard, MPharm; Roudot-Thoraval, Françoise, MD; Hézode, Christophe, MD, PhD

doi: 10.1097/ADM.0000000000000415
Original Research

Objectives: Since little is currently known about predictors of response to direct-acting antiviral agents (DAAs) in people who inject drugs, we undertook an analysis of patients attending a hepatitis clinic with addiction services (outpatient clinics and inpatient services) to examine the outcomes associated with the treatment of difficult-to-manage patients with substance use. Our experience was based on integrated care.

Method: A retrospective analysis was undertaken of 50 patients with hepatitis C virus (HCV) and a history of addiction who received treatment with DAAs, according to European guidelines. These regimens were sofosbuvir/ledipasvir for 8 weeks (n = 3), sofosbuvir/ledipasvir ± ribavirin for 12 weeks (n = 19), sofosbuvir/daclatasvir for 12 weeks (n = 20), sofosbuvir/simeprevir (n = 1), or sofosbuvir/daclatasvir for 24 weeks (n = 7). Characteristics of patients who did versus did not achieve a sustained virologic response (SVR) 12 weeks after treatment were compared by univariate analysis.

Results: Forty-two patients (84%) were male; mean age was 46.2 ± 7.3 years. Genotypes were 1 (n = 21), 2 (n = 4), 3 (n = 18), 4 (n = 6), or 6 (n = 1). Most patients were treatment-naïve (n = 38). Five patients had coinfection with human immunodeficiency virus (n = 4) or hepatitis B (n = 1), 28 (56%) had evidence of cirrhosis on FibroScan (>12.5 kPa), and 34 (68%) were receiving opioid substitution therapy. Psychiatric disease, illicit drug use, unemployment, and homelessness/precarious housing were common. Forty-five patients (90%) achieved SVR, 2 were lost to follow-up, and 3 had treatment relapse.

Conclusions: SVR was not significantly associated with sociodemographic or virological characteristics, treatment, social environment, alcohol/drug use, and adherence. Although adherence was slightly worse than in “usual” patients, it did not affect the SVR rate. In these difficult-to-manage patients with HCV and substance use disorder, the real-world SVR rate (90%) was similar to that in nonaddicted populations.

Service d’addictologie, Hôpitaux Universitaires Henri Mondor, APHP, Université Paris-Est, Créteil, France (J-BT); Service d’hépato-gastroentérologie, Hôpital Intercommunal, Créteil, France (CB); Service de pharmacie, Hôpitaux Universitaires Henri Mondor, APHP, Université Paris-Est, Créteil, France (HC); Centre Epice, Créteil, France (DC); CSAPA EGO, Association Aurore, Paris, France (AB); Centre Nova Dona, Paris, France (MB); Service d’hépatologie, Hôpital Henri Mondor, APHP, Université Paris-Est, Créteil, France (MF, FR-T, CH); Service de pharmacie, Hôpital Henri Mondor, APHP, Université Paris-Est, Créteil, France (WK-M); Service de pharmacie, Hôpital Intercommunal, Créteil, France (RC); and INSERM U955, Créteil, France (CH).

Send correspondence to Christophe Hézode, MD, PhD, Service Hépatologie, Hôpitaux Universitaires Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France. E-mail: christophe.hezode@aphp.fr.

Received 15 September, 2017

Accepted 5 March, 2018

Author contributions: CH acts as the submission's guarantor, taking responsibility for the integrity of the work as a whole. J-BT, CB, HC, DC, AB, MB, MF, WK-M, RC, FR-T, and CH all participated in reporting patient data to the study, and are responsible for the management of these patients. All authors also had a significant involvement in the data analyses. All authors were involved in the development of the primary manuscript, interpretation of data, have read and approved the final version, and have met the criteria for authorship as established by the ICMJE.

Funding: Editing support for this paper was funded using a grant received from Gilead.

Conflicts of interest: Professor Hézode has served as a speaker, advisor, and investigator for AbbVie, Bristol-Myers Squibb, Gilead, Janssen, and Merck. The other authors have nothing to declare.

© 2018 American Society of Addiction Medicine