Hepatitis C

Hep C: How Does Adherence, Injection Drug Use Impact SVR?

Individuals with hepatitis C virus (HCV) who inject drugs are able to achieve sustained virologic response (SVR) even with imperfect adherence as long as they complete treatment, according to new findings presented at the Liver Meeting 2018.

 

The findings add to a growing body of evidence that individuals who inject drugs should not be excluded from HCV treatment due to adherence concerns.

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Elana Rosenthal, MD, co-director of the DC PFAP Hepatitis Clinical Research Program at the University of Maryland, and colleagues came to this conclusion in light of preliminary findings from the ANCHOR study, which included 100 participants. At baseline, approximately 58% of participants reported injecting opioids at least daily.

 

A total of 66 patients have reached week 24 of treatment, of whom 60 (91%) received a second bottle of sofosbuvir/velpatasvir prior to running out, and 58 (88%) received a third bottle prior to running out. The investigators noted that 8 (12%) participants experienced a treatment interruption lasting 3 to 15 days.

 

Treatment adherence rates throughout the study were as follows:

  • 2 (3%) patients received 4 weeks of treatment.
  • 2 (3%) received 8 weeks of treatment.
  • 3 (5%) received 8 to 12 weeks of treatment.
  • 59 (89%) received 12 weeks of treatment.

 

Among patients who completed 12 weeks of treatment and had an anticipated end-of-treatment date:

  • 28 (48%) completed treatment 1 to 7 days after the anticipated date of completion.
  • 9 (16%) completed treatment 8 to 14 days after the anticipated date.
  • 9 (16%) completed treatment more than 14 days after the anticipated date.

 

Other notable findings:

  • Of the 58 (88%) patients who attended the week 24 visit, 52 (89.7%) achieved SVR.
  • Completing treatment after 12 weeks did not affect SVR, even among patients who were more than 14 days late in completing treatment.
  • SVR was significantly associated with:
    • An HCV viral load of less than 200 IU/mL at week 4.
    • Completing 12 weeks of treatment.
    • Receiving a second bottle of medication before running out.

 

With these findings in mind, Dr Rosenthal and colleagues emphasized in their paper that “providers should reinforce the importance of treatment completion, even in the setting of limited treatment gaps and multiple missed doses.”

 

—Christina Vogt

 

Reference:

High SVR in Pwid with HCV despite imperfect medication adherence: data from the Anchor study. Hepatology. 2018;68(S1). https://doi.org/10.1002/hep.30256.