Experience with viral hepatitis C treatment among people who inject drugs and participate in a methadone substitution treatment program

Czech version

Authors: L. Krekulová ^1,2; L. Vavrinčíková ¹
Authors‘ workplace: Remedis, s. r. o. Praha ¹; IV. Interní klinika, 1. lékařská fakulta, Univerzita Karlova a Všeobecná fakultní nemocnice v Praze ²
Published in: Epidemiol. Mikrobiol. Imunol. 70, 2021, č. 1, s. 18-25
Category: Original Papers

Overview

Objectives: Long-term monitoring of the mutual effects of chronic viral hepatitis C (VHC) treatment and tailored addiction treatment. In 2016, the World Health Organization (WHO) published an action plan to eliminate viral hepatitis C globally by 2030. People who inject drugs (PWID) are a key population that needs increased attention and care. Two decades before the announcement of the WHO plan for the global elimination of HCV (hepatitis C virus), the Remedis Medical Facility, where the study was conducted, established a “Comprehensive Care Program for patients with substance use disorders and addictive behaviour”.

Methods: We evaluated all patients who were in the methadone program as of 1 March 2020, regardless of OST duration, OST dosage, age or gender. Their epidemiological and demographic data obtained during a structured clinical interview and laboratory test results were analysed.

Results: Of 24 patients on methadone substitution therapy, 12 (50%) were anti-HCV negative before starting OST. None of them became newly infected with hepatitis C virus (HCV) during OST. The remaining 12 of the study patients were anti-HCV positive. Ten of them have already undergone successful treatment for viral hepatitis. Two patients were re-infected with HCV.

Conclusion: The presented work confirms the high efficacy of chronic VHC treatment among PWID in inducing suitable conditions. We consider combination of HCV infection treatment and targeted tailored addiction treatment as a starting point for achieving control over the HCV epidemic in the Czech Republic, with a possible positive impact on other blood-borne infections related to risky behaviour.

Keywords:

HCV (hepatitis C virus) – VHC (viral hepatitis C) – PWID (People Who Injected Drugs) – OST (opioid substitution treatment) – MTD (methadone) – Remedis, Prague

Sources

1. Global Hepatitis Report 2017 [online]. Geneva: World Health Organization [cit. 2020-02-28]. Dostupný na www: https://apps.who.int/iris/bitstream/handle/10665/255016/9789241565455-eng.pdf?sequence=1.

2. Blach S, Zeuzeum S, Manns M, et al. Global prevalence and genotype distribution of hepatitis C virus infection in 2015: a modelling study. The Lancet [online], 2017;2(3):161–176. [cit. 2020-05-01]. Dostupný na www: https://linkinghub.elsevier.com/retrieve/pii/S2468125316301819.

3. Stanaway D, Flaxman AD, Naghavi M, et al. The global burden of viral hepatitis from 1990 to 2013: findings from the Global Burden of Disease Study 2013. The Lancet [online], 2016; 388(10049):1081–1088 Dostupný z www: https://linkinghub.elsevier.com/retrieve/pii/S0140673616305797.

4. Razavi H, Elkhoury C, Elbasha E, et al. Chronic hepatitis C virus (HCV) disease burden and cost in the United States. Hepatology, 2013;57(6):2164–2170. Dostupný z www: http://doi.wiley.com/10.1002/hep.26218.

5. Buckley GJ, Strom BL. Eliminating the public health problem of hepatitis B and C in the United States: phase one report. Washington, DC: the National Academies Press, 2016.

6. Zibbel JE, Iqbal KC, Patel RC, et al. Increases in hepatitis C virus infection related to injection drug use among persons aged ≤30 years – Kentucky, Tennessee, Virginia, and West Virginia, 2006-2012. MMWR. Morbidity and mortality weekly report, 2015; 64(17): 453–458.

7. Suryaprasad AG, White JZ, Xu F, et al. Emerging Epidemic of Hepatitis C Virus Infections Among Young Nonurban Persons Who Inject Drugs in the United States, 2006–2012. Clinical Infectious Diseases [online], 2014; 59(10): 1411-1419. [cit. 2020-04-16]. Dostupný na www: https://academic.oup.com/cid/article-lookup/doi/10.1093/cid/ciu643.

8. Guidelines for the screening care and treatment of persons with chronic hepatitis C infection, 2016. Updated version April 2016. Geneva: World Health Organization. ISBN 978-92-4-154961-5. [cit. 2020-04-16]. Dostupný na www: https://apps.who.int/iris/bitstream/handle/10665/205035/9789241549615_eng.pdf?sequence=1.

9. Hajarizadeh B, Cunningham EB, Reid H, et al. Direct-acting antiviral treatment for hepatitis C among people who use or inject drugs: a systematic review and meta-analysis [online], 2018;3(11). [cit. 2020-03-31]. Dostupný z www: https://linkinghub.elsevier.com/retrieve/pii/S2468125318303042.

10. Grebbely J, Larney S, Peacock A, et al. Global, regional, and country-level estimates of hepatitis C infection among people who have recently injected drugs. Addiction [online], 2019;114(1):150–166. [cit. 2020-03-31]. Dostupný z www: http://doi.wiley.com/10.1111/add.14393.

11. Hagan H, Pouget ER, Des Jarlais DC, et al. Meta-Regression of Hepatitis C Virus Infection in Relation to Time Since Onset of Illicit Drug Injection: The Influence of Time and Place. American Journal of Epidemiology [online], 2008;168(10):1099–1109. [cit. 2020-03-31]. Dostupný na www: https://academic.oup.com/aje/article-lookup/doi/10.1093/aje/kwn237.

12. Wiessing L, Ferri M, Grady B, et al. Hepatitis C Virus Infection Epidemiology among People Who Inject Drugs in Europe: A Systematic Review of Data for Scaling Up Treatment and Prevention. PLoS ONE [online], 2014; 9(7): Dostupný na www: https://dx.plos.org/10.1371/journal.pone.0103345.

13. Global Health Sector Strategy on Viral Hepatitis 2016 - 2021: Towards ending viral hepatitis [online], 2016. In: Geneva: World Health Organization, s. 1–56 [cit. 2020-07-31]. Dostupný na www: https://apps.who.int/iris/bitstream/handle/10665/246177/WHO-HIV-2016.06-eng.pdf?sequence=1.

14. Degenhardt L, Charlson F, Stanaway J, et al. Estimating the burden of disease attributable to injecting drug use as a risk factor for HIV, hepatitis C, and hepatitis B: findings from the Global Burden of Disease Study 2013. The Lancet Infectious Diseases [online], 2016;16(12): 1385–1398. [cit. 2020-03-31]. Dostupný na www: https://linkinghub.elsevier.com/retrieve/pii/S1473309916303255.

15. Degenhardt L, Peacock A, Colledge S, et al. Global prevalence of injecting drug use and sociodemographic characteristics and prevalence of HIV, HBV, and HCV in people who inject drugs: a multistage systematic review. The Lancet Global Health [online], 2017;5(12):1192–1207. [cit. 2020-03-31]. Dostupný na www: https://linkinghub.elsevier.com/retrieve/pii/S2214109X17303753.

16. Edlin BR, Eckhardt BJ, Shu MA, et al. Toward a more accurate estimate of the prevalence of hepatitis C in the United States: a multistage systematic review. Hepatology [online], 2015;62(5):1353–1363. [cit. 2020-07-31]. Dostupný na www: http://doi.wiley.com/10.1002/hep.27978.

17. Denniston M, Klevens R, Mcquillan G, et al. Awareness of infection, knowledge of hepatitis C, and medical follow-up among individuals testing positive for hepatitis C: National Health and Nutrition Examination Survey 2001–2008. Hepatology [online], 2012;55(6): 1652–1661. [cit. 2020-07-31]. Dostupný na www: http://doi.wiley.com/10.1002/hep.25556.

18. Němeček, VJ, Částková P, Fritz A, et al. The 2001 serological survey in the Czech Republic-viral hepatitis. Central European Journal of Public Health, 2003;11(Supplement): S54–61.

19. Horák J, Střítezký J. Chronické hepatitidy. Praha: Grada, 1999.

20. Husa P, Střítezký J. Léčba virových hepatitid. Praha: Triton. Levou zadní, 2000.

21. Mravčík V, Chomynová P, Grohmannová K, et al. Výroční zpráva o stavu ve věcech drog pro Evropské monitorovací středisko pro drogy a drogové závislosti: Česká republika, 2017. Praha: Úřad vlády ČR, 2018. ISBN 978-80-7440-219-7.

22. Zabransky T, Mravcik V, Korcisova B, et al. Hepatitis C Virus Infection among Injecting Drug Users in the Czech Republic – Prevalence and Associated Factors. European Addiction Research [online], 2006;12(3):151–160. [cit. 2020-03-31]. Dostupný na www: https://www.karger.com/Article/FullText/92117.

23. Mravčík, V, Chomynová P, Grohmannová K, et al. Výroční zpráva o stavu ve věcech drog v České republice v roce 2018. Praha: Úřad vlády ČR, 2019. ISBN 978-80-7440-237-1.

24. Mravčík V, Šebáková H. Výskyt virových hepatitid typu B a C u injekčních uživatelů drog v okrese Karviná. Adiktologie, 2002;2(2):19–27.

25. Mravčík V. Výskyt VHC u injekčních uživatelů drog: Výsledky studie prováděné mezi klienty nízkoprahových zařízení v letech 2002–2005 [online], 2009. Praha: Úřad vlády České republiky. [cit. 2020-01-27]. Dostupný na www: https://www.drogy-info.cz/data/download/91330/393423/file/5_Vyskyt_VHC_u_injekcnich_uzivatelu_drog_ePubl.pdf.

26. Mravčík V., Janíková B., Dlouhý P. (ed.) Eliminace virové hepatitidy typu C mezi uživateli drog v České republice: východiska a akční plán na období 2019–2021. Praha: Úřad vlády České republiky, 2019.

27. Global Health Sector Strategy on Viral Hepatitis 2016 - 2021: Towards ending viral hepatitis [online], 2016. In: Geneva: World Health Organization, p. 1–56 [cit. 2020-07-31]. Dostupný na www: https://apps.who.int/iris/bitstream/handle/10665/246177/WHO-HIV-2016.06-eng.pdf?sequence=1.

28. Mitchell O, Gurakar A. Management of Hepatitis C Post-liver Transplantation: a Comprehensive Review. Journal of Clinical and Translational Hepatology [online], 2015;3(2). [cit. 2020-07-31]. Dostupný na www: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4548349/pdf/JCTH-3-140.pdf.

29. Limketkai, BN, Mehta S, Sutcliffe CG, et al. Relationship of Liver Disease Stage and Antiviral Therapy With Liver-Related Events and Death in Adults Coinfected With HIV/HCV. JAMA [online], 2012:308(4). [cit. 2020-03-31]. Dostupný na www: http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2012.7844.

30. Hickman M, De Angelis D, Vickerman P, et al. Hepatitis C virus treatment as prevention in people who inject drugs. Current Opinion in Infectious Diseases [online], 2015;28(6):576–582. Dostupný na www: http://journals.lww.com/00001432-201512000-00012.

31. Tucker JD, Meyers K, Best J, et al. The HepTestContest: a global innovation contest to identify approaches to hepatitis B and C testing. BMC Infectious Diseases [online], 2017;17(S1). [cit. 2020-07-31]. Dostupný na www: http://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-017-2771-4.

32. Edland-Gryt M, Skatvedt AH. Thresholds in a low-threshold setting: An empirical study of barriers in a centre for people with drug problems and mental health disorders. International Journal of Drug Policy [online], 2013;24(3):257–264. [cit. 2020-07-31]. Dostupný na www: https://linkinghub.elsevier.com/retrieve/pii/S0955395912001193.

33. Krekulova L, Rehak V, Madrigal N, et al. Genotypic and Epidemiologic Characteristics of Hepatitis C Virus Infections among Recent Injection Drug User and Nonuser Populations. Clinical Infectious Diseases [online], 2001;33(8):1435–1438. [cit. 2020-03-31]. Dostupný na www: https://academic.oup.com/cid/article-lookup/doi/10.1086/323199.

34. Krekulová L, Řehák V, Oktábec Z, et al. HCV genotype shift occurred over the 15 years in PWIDs in the Czech Republic. Epidemiology, Microbiology, Immunology [online], 2019;68(1): 3–8. [cit. 2020-03-31]. Dostupný na www: https://www.prolekare.cz/casopisy/epidemiologie/2019-1-20/vyvoj-v-zastoupeni-genotypu-hcv-u-injekcnich-uzivatelu-drog-v-ceske-republice-behem-15-let-112615/download?hl=cs.

35. European Drug Report: Trends and Developments [online]. In: Luxembourg: Publications Office of the European Union. Lisbon: The European Monitoring Centre for Drugs and Drug Addiction, 2016:1–84. [cit. 2020-07-31]. Dostupný na www: https://www.emcdda.europa.eu/system/files/publications/2637/TDAT16001ENN.pdf .

36. Asselah T, Marcellin P, Schinazi RF. Treatment of hepatitis C virus infection with direct-acting antiviral agents: 100% cure?. Liver International, 2018;38(2):7–13. DOI: 10.1111/liv.13673. ISSN 14783223. [cit. 2020-03-31]. Dostupný na www: http://doi.wiley.com/10.1111/liv.13673.

37. Dillon JF, Lazarus JV, Razavi HA. Urgent action to fight hepatitis C in people who inject drugs in Europe. Hepatology, Medicine and Policy [online], 2016;1(1). Dostupný na www: http://hmap.biomedcentral.com/articles/10.1186/s41124-016-0011-y.

38. Platt L, Minozzi S, Reed J, et al. Needle and syringe programmes and opioid substitution therapy for preventing HCV transmission among people who inject drugs: findings from a Cochrane Review and meta-analysis. Addiction, 2018;113(3):545–563. DOI: 10.1111/add.14012. ISSN 09652140. Dostupný na www: http://doi.wiley.com/10.1111/add.14012.

39. Grebely J, Dalgard O, Conway B, et al. Sofosbuvir and velpatasvir for hepatitis C virus infection in people with recent injection drug use (SIMPLIFY): an open-label, single-arm, phase 4, multicentre trial. The Lancet Gastroenterology & Hepatology [online], 2018;3(3):153–161 [cit. 2020-08-20]. DOI: 10.1016/S2468-1253(17)30404-1. ISSN 24681253. [cit. 2020-07-31]. Dostupný na www: https://linkinghub.elsevier.com/retrieve/pii/S468125317304041.

40. Midgard H, Bjǿro B, MÆland, A, et al. Hepatitis C reinfection after sustained virological response. Journal of Hepatology, 2016;64(5):1020–1026. DOI: 10.1016/j.jhep.2016.01.001. ISSN 01688278. Dostupný na www: https://linkinghub.elsevier.com/retrieve/pii/S0168827816000039.

41. Midgard H, Weir A, Palmateer A, et al. HCV epidemiology in high-risk groups and the risk of reinfection. Journal of Hepatology, 2016;65(1):S33–S45. DOI: 10.1016/j.jhep.2016.07.012. ISSN 01688278. Dostupný na www: https://linkinghub.elsevier.com/retrieve/pii/S0168827816303361.

42. Simmons B. Saleem J, Hill A, et al. Risk of Late Relapse or Reinfection With Hepatitis C Virus After Achieving a Sustained Virological Response: A Systematic Review and Meta-analysis. Clinical Infectious Diseases, 2016;62(6):683–694. DOI: 10.1093/cid/civ948. ISSN 1058-4838. Dostupný na www: https://academic.oup.com/cid/article-lookup/doi/10.1093/cid/civ948.

43. Dore GJ, Greberly J, Altice F, et al. Hepatitis C Virus (HCV) Reinfection and Injecting Risk Behavior Following Elbasvir (EBR)/Grazoprevir (GZR) Treatment in Participants on Opiate Agonist Therapy (OAT): Co-STAR Part B [ABSTRACT 195]. Hepatology, 2017;66(S1):112A. DOI: 10.1002/hep.29500. ISSN 02709139. Dostupný na www: https://aasldpubs.onlinelibrary.wiley.com/doi/epdf/10.1002/hep.29500.

44. Page KM, Morris D, Hahn JA, et al. Injection Drug Use and Hepatitis C Virus Infection in Young Adult Injectors: Using Evidence to Inform Comprehensive Prevention. Clinical Infectious Diseases, 2013;57(suppl_2):S32–S38. DOI: 10.1093/cid/cit300. ISSN 1537-6591. Dostupný na www: http://academic.oup.com/cid/article/57/suppl_2/S32/397297/Injection-Drug-Use-and-Hepatitis-C-Virus-Infection.

45. Heffernan A, Cooke GS, Nayagam S, et al. Scaling up prevention and treatment towards the elimination of hepatitis C: a global mathematical model. The Lancet [online], 2019;393(10178): 1319–1329. [cit. 2020-07-31]. Dostupný na www: https://linkinghub.elsevier.com/retrieve/pii/S0140673618322773.

46. Martin NK, Vickerman P, Hickman M. Mathematical modelling of hepatitis C treatment for injecting drug users. Journal of Theoretical Biology [online], 2011;274(1):58–66. [cit. 2020-07-31]. Dostupný na www: https://linkinghub.elsevier.com/retrieve/pii/S0022519311000038..