Expert Q&A

Rapid Hepatitis C Virus Treatment Initiation

Young adults who inject drugs are among the most vulnerable populations for hepatitis C virus (HCV) infection. Rapid initiation of treatment in these individuals is critical for reducing the prevalence of HCV in the United States.

In a recent clinical trial, researchers examined a new strategy for rapidly diagnosing and treating HCV in this patient population. Study author Benjamin Eckhardt, MD, who is an assistant professor in the Department of Medicine at NYU Grossman School of Medicine, answered our questions about the study findings. Dr Eckhardt recently presented these study findings at the Infectious Diseases Society of America’s 2021 Annual Conference, IDWeek.1

Consultant360: To begin, could you give us a brief overview of your research?

Benjamin Eckhardt, MD:  Our project is a small, randomized pilot program aimed at exploring a novel strategy to better engage HCV-positive young people who inject drugs (PWID) in treatment. Young PWID are a crucial population to address with current HCV elimination efforts, as a large proportion of HCV transmission is occurring in the group and treatment provides a strategy to interrupt/reduce continued HCV transmission. Our goal was to make treatment as simple and easy as possible for this population without the need for multiple medical/clinic visits and the removal in the delay in medication acquisition that results from the insurance prior authorization process.

C360: What is the current standard of care for initiating HCV treatment in newly diagnosed young adults?

Dr Eckhardt: Even with the current recommended “simplified” treatment strategy that is part of the IDSA/AASLD2, the current standard of care for HCV treatment includes a baseline medical visit, waiting for baseline laboratory test results, then prior authorization application for medication. This process may require adherence to several medical visits for at least 2 to 4 weeks. We feel that this need for adherence to multiple visits results in lower rates of treatment initiation that would be possible with a rapid test-and-treat model.

C360: What are some clinical pearls you would give your peers for the rapid initiation of HCV treatment in young PWID?

Dr Eckhardt: Young PWID are eager and willing to get treated and cured for HCV. However, many are not ready to prioritize multiple medical visits to get initiated on treatment. By removing barriers to treatment initiation, young PWID will start treatment and will achieve cure rates compared with other patient populations. Treating this group has the additional benefit of potentially reducing further infection transmission in this high-risk group.

C360: What knowledge gaps remain about diagnosing and managing HCV in this patient population?

Dr Eckhardt: By getting young PWID on treatment rapidly and decreasing the time it takes for an individual to have an undetectable viral load, we are likely impacting the community viral load. Hypothetically this reduction in viral load will have a "treatment-as-prevention" effect. What remains to be examined is the rate of HCV reinfection in this particular population and the willingness of young PWID to be retreated with each repeated infection.

 

References:

  1. Eckhardt B. Rapid hepatitis C treatment initiation in young people who inject drugs: final results from the HCV-Seek, Test & Rapid Treatment (HCV-ST&RT) randomized pilot clinical trial. Paper presented at: IDWeek 2021; September 29-October 3, 2021. Accessed September 29, 2021. https://www.eventscribe.net/2021/IDWeek/ajaxcalls/PosterInfo.asp?efp=RFpCTVlJWUkxNDI1Nw&PosterID=413064&rnd=0.7055475&query=Rapid%20hepatitis%20C%20treatment%20initiation%20in%20young%20people%20who%20inject%20drugs
  2. Simplified HCV treatment for treatment-naïve adults without cirrhosis. Infectious Diseases Society of America. Updated August 27, 2020. Accessed September 29, 2021. https://www.hcvguidelines.org/treatment-naive/simplified-treatment