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DAAs efficacy impaired in persons who had ever injected drugs

23 Jun 2019

Persons who had ever injected drugs (PWID), either on opiate agonist therapy (OAT) or not, do not respond to direct-acting antiviral agents (DAA) as well as those who had never used drugs, a new study has shown.

The study included 1,752 patients with hepatitis C virus (HCV) infections. Sustained viral response 12 weeks after treatment (SVR12) was compared between those who had never injected drugs (n=818; median age, 54 years; 62 percent male) and PWIDs with (n=199; median age, 48 years; 92 percent male) and without (n=735; median age, 50 years; 85 percent male) OAT.

In the intention-to-treat analysis, 93 percent (n=1,628) achieved SVR12. Stratifying according to drug use behaviours, SVR12 was found to be highest among those who had never injected drugs (95 percent; n=778). In PWIDs with vs without OAT use, the corresponding rates were 89 percent and 92 percent.

Fifty-three patients relapsed at the end of treatment response, 17 of whom had confirmed relapses via phylogenetic analysis. Reinfection was determined in three patients who turned out to be PWIDs who had achieved SVR 4 weeks after the end of therapy.

Multivariate analysis identified ongoing drug use (odds ratio [OR], 0.22, 95 percent CI, 0.11–0.42; p<0.001), coinfection with HIV (OR, 0.57, 0.34–0.96; p=0.036) and cirrhosis (OR, 0.46, 0.30–0.71; p<0.001) as factors significantly predictive of lower SVR12 rates.

“In conclusion, HCV cure rates with interferon-free DAA combinations are high among PWID with and without OAT. However, the overall efficacy of DAAs in active drug users is lower, mainly due to losses of follow-up,” said researchers, noting that strategies that aim to improve adherence among PWIDs are needed.

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Most Read Articles
2 days ago
Exposure to corticosteroids in patients with autoimmune hepatitis (AIH) appears to contribute to increased risks of cataract, diabetes and bone fractures, a study has found. Notably, the fracture risk is elevated at low doses, while the risk of adverse events overall is dose-dependent and is reversible.
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Supplementation with omega-3 fatty acids or vitamin D3 for up to 5 years has no effect on kidney function in adults with type 2 diabetes (T2D), the VITAL-DKD* ancillary study has shown.
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Many patients with nonvalvular atrial fibrillation (NVAF) in Thailand use anticoagulants, but the uptake of nonvitamin-K oral anticoagulants remains suboptimal despite showing an upward trend, according to data from the COOL-AF registry presented at the European Society of Cardioloy (ESC) Asia Congress 2019 with APSC and AFC.