HIV/HCV infected drug users an ideal population for direct-acting antiviral use

Direct-acting antiviral (DAA) therapies offer an opportunity to expand treatment access to patients co-infected with HIV and hepatitis C virus (HCV) who use illicit drugs, according to the first study to assess the willingness of this population to use DAA-based regimens.

Despite high prevalence and worse clinical outcomes among co-infected individuals, previous studies evaluating willingness to undergo HCV treatment have mostly focused on HCV-infected people who use drugs (PWUD).

“Understanding prevalence and factors shaping willingness to use DAA-based regimens among HIV/HCV co-infected PWUD is the first step for any strategy aiming to expand access and uptake of HCV treatment in this population,” lead author Eugenia  Socías MD, MSc, postdoctoral fellow at the University of British Columbia, told Medical Economics.

The researchers published their results in October 2017 HIV Medicine.

Using logistic regression analyses, Socias and colleagues investigated factors associated with willingness to use DAA-based regimens among 418 HIV/HCV co-infected PWUD. The researchers reported 71% of the patients were willing to use DAA-based regimens. “In particular, engagement in addiction (methadone maintenance treatment) and HCV care (recent assessment by a HCV specialist), as well as holding the perception that HCV was affecting participant’s health, were associated with increased odds of reporting willingness to use DAAs,” said Socias.

These findings are in line with past research conducted among HCV-infected individuals, and in the interferon era, she noted.

The results also emphasize the significant gap between willingness to undergo HCV treatment among HCV-positive PWUD and actual treatment uptake. “While HCV treatment uptake rates have improved in the DAA era, the majority of HCV/HIV co-infected PWUD do not access HCV treatment due to multiple barriers, including high costs, restrictions to reimbursement related to drug/alcohol use or the requirement of a specialist to prescribe treatment, and stigma and misperceptions from health care providers,” said Socias.

One of the key findings of the study is that enrollment in methadone maintenance treatment programs was positively associated with willingness to use newer HCV treatments. This finding supports the key role of opioid agonist treatment programs to improve HCV treatment and prevention outcomes, and also suggests that integrated models of addiction and HCV care may have potential to increase access and uptake of DAA-based treatment among PWUD, said Socias.

Several modelling studies show expanding access to HCV treatment to PWUD is a potentially highly cost-effective public health concept. Similar to treatment as prevention strategies in HIV, curing HCV not only benefits the individual patient, but also provides a secondary benefit by reducing the risk of HCV transmission, she said.

Prevalence of HCV is high among PWUD, and particularly among those living with HIV.

“Every time one of these co-infected patients comes to our office, we need to offer HCV testing. Most patients who have chronic HCV can be safely treated using the newer DAA-based regimens in a primary care setting. Confronting stigma and misperceptions about the potential of PWUD to adhere to treatment or their choice of certain behaviors is also key to increase access to care for this population,” said Socias.