DAA therapy can cure hepatitis C in people who inject drugs
A systematic review conducted by researchers at the Kirby Institute shows 9-in-10 people who inject drugs have been cured of hepatitis C with direct-acting antiviral (DAA) therapy.
“The results of our research show that the response to hepatitis C therapy among people who inject drugs was very favourable. Across almost 40 studies worldwide, involving more than 3,500 people with recent or ongoing drug use, hepatitis C was cured in almost nine out of 10 people,” said lead author Dr Behzad Hajarizadeh, of the Viral Hepatitis Clinical Research Program at the Kirby Institute, Kensington, New South Wales, Australia. [Lancet Gastroenterol Hepatol2018 Sep 20. pii: S2468-1253(18)30304-2]
“We conducted a systematic review, which means we examined all the available evidence from studies conducted globally on this topic. It means we can be very confident about these results.”
Since March 2016, Australia has offered broad access to hepatitis C treatment through its Pharmaceutical Benefits Scheme (PBS) which resulted in significant reductions in hepatitis C among people who inject drugs. A Kirby Institute analysis found that the prevalence of active hepatitis C infection among people attending needle and syringe programmes reduced from 43 percent to 25 percent between 2015 and 2017.
“The World Health Organization has set a target to eliminate hepatitis C by 2030,” said Associate Professor Jason Grebely, of the Kirby Institute. “Our data provides robust evidence to inform global clinical guidelines, and we hope it will improve public health policy for hepatitis C treatment for people who use drugs internationally. This will bring us closer to the ambitious goal of global elimination.”
The Kirby Institute research provides the strongest evidence-base to date to support the availability of DAA therapy to people who inject drugs. In many countries, people who inject drugs can’t access DAA therapy due to restrictions on treatment reimbursement related to their recent drug use. Also, many clinicians are reluctant to prescribe DAA therapy to people who use or inject drugs, as there are concerns about compliance and the chance of reinfection.
“People should not be denied life-saving treatments, simply because of their recent drug use,” said Grebely, also the President of the International Network of Hepatitis in Substance Users (INHSU). “Policies that deny hepatitis C treatment for people who use or inject drugs are unacceptable; they are driven by discrimination as opposed to evidence. I hope our research will encourage countries to overturn these policies and allow treatment to all people living with hepatitis C, regardless of current or previous drug use. In fact, given high prevalence rates, people who inject drugs really should be prioritized for treatment.”
In September 2018, delegates from key hepatitis C research and advocacy organizations gathered at the Portuguese National Parliament and signed the ‘Global Declaration to Eliminate Hepatitis C in People Who Use Drugs,’ in which they called on world political leaders to adopt the United Nations goal of hepatitis C elimination by 2030. The Declaration outlines seven actions to close the “gap between the global impact of hepatitis C on the health and well-being of people who use drugs and the limited access to evidence-based services effective for the prevention, diagnosis and treatment of hepatitis C infection.”