Path to eradicate HCV goes through people who inject drugs

Emerging research suggests that targeting HCV-infected people who inject drugs for treatment would deplete the pool of HCV and reduce overall transmission, eventually leading to HCV eradication. People who inject drugs represent the most at-risk population for acquiring HCV infection, and prevention efforts should continue to focus on them, said Zabair Younossi, MD, chairman of the Department of Medicine at Inova Fairfax Hospital in Falls Church, Virginia, who was not associated with the review. He told Medical Economics that efforts to scale up HCV treatment in persons who inject drugs is necessary to positively impact HCV in the United States and around the world.

“It is important for healthcare practitioners to understand the comprehensive and multi-faceted picture of this disease. It is only through this comprehensive approach to HCV and its treatment that we will understand the full impact of this disease and the tremendous gains that have been achieved with the new direct-acting antiviral (DAA) regimens,” said Younossi. He believes DAAs have led to eradication of HCV in most infected patients.

Modelling studies have shown that the prevalence of chronic HCV could be reduced by treating those at risk of ongoing HCV transmission, according to a recent review led by senior author J. F. Dillon of the Division of Molecular and Clinical Medicine for the School of Medicine at Ninewells Hospital and Medical School, University of Dundee, United Kingdom. “The high incidence of HCV among key populations such as people who inject drugs, men who have sex with men and prisoners represent an ideal opportunity to curb ongoing HCV transmission,” the authors write.

The authors published their review in July 2016 Alimentary Pharmacology & Therapeutics.

The main driver for new HCV infection is the injection of drugs with contaminated needles. The authors suggest that providing clean needles and other injecting equipment, along with access to opiate replacement therapy for opiate users, should reduce the risk of HCV transmission. Since most people are unaware of their HCV status, vaccination might be the most effective way of eradicating HCV, and several HCV vaccine trials are ongoing. They note that people who inject drugs who achieve a sustained virological response with treatment are more likely to pursue a healthy lifestyle.

“Perhaps the most important prevention strategy is the implementation of HCV testing so as to identify those in need of treatment. Solutions must be formulated to overcome barriers to care. In this way, more patients eligible to be treated are identified and managed accordingly. Early identification, using more accurate diagnostic tools, will be essential to prevent the onward transmission of HCV,” write the authors.

New clinical guidelines suggest that HCV treatment should be offered to people with a transmission risk, including people who inject drugs, irrespective of severity of liver disease. Zounossi agrees: “I think everyone should be treated regardless of disease severity or age,” adding that patients with more advanced liver disease and extrahepatic manifestations should be prioritized to treatment.