Rapid treatment significantly increases HCV cure rate among injection drug users
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A rapid treatment model that included a 7-day starter pack of medication significantly increased hepatitis C cure rates among young people who inject drugs, according to a small study.
“When a pathogenic infectious disease is diagnosed and well-tolerated curative therapy is available, treatment is typically not delayed,” Benjamin J. Eckhardt, MD, MS, assistant professor of infectious diseases and immunology at the New York University School of Medicine, told Healio.
Eckhardt said rapid initiation of treatment can limit the progression of disease, improve treatment outcomes and prevent transmission.
“Given the slow progression of hepatitis C virus, there has not been a strong emphasis on rapid treatment initiation,” he said.
Eckhardt explained that HCV treatment cascades have often demonstrated significant drop-offs after HCV screening, with suboptimal rates of engagement, treatment initiation and cure. He noted several logistical barriers to treatment, including insurance authorization, multistep pretreatment workup and multiple medical visits.
“One population that has proven difficult to engage in HCV care is young people who inject drugs, yet this might be one of the most important groups to treat and cure as they are a population that is at high risk to subsequently transmit their infection,” Eckhardt said. “In our study, we tried to simplify HCV treatment and start medication without unnecessary delay in an attempt to cure more young people who inject drugs of their HCV infection.”
Eckhardt and colleagues recruited 47 people aged 18 to 29 years who were HCV antibody-positive, treatment naive and had used injection drugs in the last 30 days. They randomly assigned participants in a 1:1 ratio to receive rapid treatment same-day medical evaluation, confirmatory and baseline lab testing, and a 7-day starter pack of sofosbuvir/velpatasvir at a syringe service program (SSP) or usual care, which consisted of HCV confirmatory testing at the SSP and referral to local providers if the participant was HCV positive.
According to the study, 25 participants had confirmed HCV and were included in the modified intention to treat analysis. Overall, nine of the 14 in the rapid treatment arm (64%) and one of the 11 in the usual care arm (9.1%) achieved a confirmed SVR (P = .01).
“Meeting young people who inject drugs where they're at and initiating HCV treatment ‘in the moment’ without the need for repeat visits appears to be a promising strategy for treating this hard-to-reach population,” Eckhardt said. “To expand rapid treatment broadly, insurance companies will have to be pressured to remove their clinically unnecessary prior authorization process that is simply in place to control cost — that is, increase profits.”
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