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Homelessness May Be A Barrier To Success For Hepatitis C ‘Treatment As Prevention’ Programmes

ILC 2019: ‘Treatment as Prevention’ programme for hepatitis C in Iceland reports high levels of cure, but homelessness is found to be a barrier to success

11 April 2019, Vienna, Austria

EASL (EUROPEAN ASSOCIATION FOR THE STUDY OF THE LIVER)

A national ‘Treatment as Prevention’ programme for hepatitis C has today reported high levels of cure but found that homelessness more than doubles the chance of failing treatment with direct-acting antiviral (DAA) drugs. First results from the Treatment as Prevention for Hepatitis C (TraP HepC) initiative in Iceland, which were reported today at The International Liver Congress™ 2019 in Vienna, Austria, indicate that a cure from HCV infection can be achieved with one course of treatment in almost 90% of programme participants, although cure rates may be lower among injection drug users.

Injection drug use is the most important risk factor for hepatitis C virus (HCV) transmission in many countries, and the prevalence of HCV infection is highest among people who inject drugs (PWID) than among any other risk group.1,2 Multiple studies have provided evidence that people with HCV who inject drugs can be treated successfully with antiviral drugs, yet access to treatment across Europe still appears to be limited.3

In an effort to improve this situation and achieve World Health Organization HCV elimination targets, many countries in Europe have implemented harm reduction and/or hepatitis C elimination programmes, which build on the concept of treatment to prevent onward transmission of HCV.3,4 The TraP HepC programme in Iceland was launched in January 2016 and since the launch of the programme, all HCV-positive individuals have been offered direct-acting antiviral (DAA) agents, with priority groups including PWID and those with advanced liver disease.4

‘During the first 2 years of the programme, 631 individuals – which amounts to 80% of the estimated HCV-infected population in Iceland – were initiated on DAA treatment,’ explained Dr Magnús Gottfredsson from the National University Hospital in Reykjavik, Iceland, who presented the first results from the programme. ‘Recent injection drug use was reported by 210 of these individuals, with more than half injecting in the 30 days prior to treatment.’

‘Forty individuals in our cohort (6.3%) were homeless.’

According to Dr Gottfredsson, in the ITT analysis the overall cure rate after the first treatment attempt was 89.2%. Cure was achieved in a significantly smaller proportion of the cohort reporting injection drug use within the past 6 months (82.9%) compared with the cohort without recent injection drug use (92.4%; p<0.0001). Individuals with recent injection drug use were more likely to discontinue treatment (15.2% vs. 4.5%; p<0.0001), however, even when the analysis was restricted to those who completed treatment, the chance of cure was lower among those with recent injection drug use (89.9% vs. 95.3%; p=0.025).

Homelessness was associated with a greater chance of persistent viraemia at ≥12 weeks, with a relative risk (RR) of 2.42 (95% CI 1.34, 4.37; p=0.007), while living in a halfway house was associated with a lower risk (RR 0.37; 95% CI 0.12, 1.16; p=0.068).

‘Overall, in its first 2 years, the Trap HCV programme has achieved high rates of treatment success among some difficult-to-reach and -treat HCV-infected populations,’ said Dr Gottfredsson. ‘We were concerned, however, to find that homelessness is a risk factor for treatment failure, which we suspect is due to treatment discontinuation. Interventions must be targeted towards this group of individuals to limit the spread of HCV infection.’

’This is an important study, since it demonstrated the feasibility of treating this group of patients, although with a lower rate of success’ said Professor Helena Cortez-Pinto from the Hospital Universitário de Santa Maria, Lisbon, Portugal, and an EASL Governing Board member.

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About The International Liver Congress™

This annual congress is the biggest event in the EASL calendar, attracting scientific and medical experts from around the world to learn about the latest in liver research. Attending specialists present, share, debate and conclude on the latest science and research in hepatology, working to enhance the treatment and management of liver disease in clinical practice. This year, the congress is expected to attract approximately 10,000 delegates from all corners of the globe. The International Liver Congress™ 2019 will take place from 10­–14 April 2019 at the Reed Messe Wien Congress and Exhibition Center, Vienna, Austria.

About The European Association for the Study of the Liver (EASL)

Since its foundation in 1966, this not-for-profit organization has grown to over 4,000 members from all over the world, including many of the leading hepatologists in Europe and beyond. EASL is the leading liver association in Europe, having evolved into a major European association with international influence, and with an impressive track record in promoting research in liver disease, supporting wider education and promoting changes in European liver policy.

Contact

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Onsite location reference

Session title: ‘Cascade of care towards elimination of viral hepatitis’

Time, date and location of session: 17:45–18:00, 11 April 2019, Strauss 3

Presenter: Magnús Gottfredsson, Iceland

Abstract: Is homelessness the biggest hurdle to treatment success in the management of HCV in the era of direct acting antivirals? Results from the TraP HepC nationwide treatment initiative in Iceland (PS-072)

Author disclosures

Magnús Gottfredsson has received speaking fees from Gilead. Gilead provided DAAs at no cost to the TraP Hepatitis C Program in an epidemiological study setting

References

  1. Alter MJ. HCV routes of transmission: what goes around comes around. Semin Liver Dis. 2011;31(4):340–6.
  2. Martin NK, et al. The hepatitis C virus epidemics in key populations (including people who inject drugs, prisoners and MSM): the use of direct-acting antivirals as treatment for prevention. Curr Opin HIV AIDS. 2015;10(5):374–80.
  3. Wiessing L, 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. 2014;9(7):e103345.
  4. Olafsson S, et al. Treatment as Prevention for Hepatitis C (TraP Hep C) – a nationwide elimination programme in Iceland using direct-acting antiviral agents. J Intern Med. 2018;283(5):500–7.