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Abstract Details
Factors Enhancing Treatment of Hepatitis C Virus-Infected Italian People Who Use Drugs: The CLEO-GRECAS Experience
Am J Gastroenterol. 2021 Jun 1;116(6):1248-1255.doi: 10.14309/ajg.0000000000001147.
Luca Rinaldi1, Vincenzo Messina2, Vito Di Marco3, Vincenzo Iovinella4, Ernesto Claar5, Giuseppe Cariti6, Rodolfo Sacco7, Massimo De Luca8, Gaetano Scifo9, Pietro Gatti10, Giorgio Barbarini11, Valeria Pace Palitti12, Mariano Quartini13, Paolo Tundo14, Gianpiero D'Offizi15, Giustino Parruti16, Maria Antonietta di Rosolini17, Giovanni Garrucciu18, Lucio Cosco19, Francesco Benanti20, Giancarlo Gimignani21, Umberto Vespasiani Gentilucci22, Francesco Di Lorenzo23, Maria D'Antò24, Riccardo Nevola1, Tommaso Lupia6, Valerio Rosato5, Valeria Morbiducci13, Ilaria Luzzitelli15, Federica Sozio16, Marco Di Stefano9, Emanuela Ciraci10, Fabio Bulla19, Riccardo Guarisco21, Cecilia Cangiano1, Michele Imparato25, Paolo Maggi2, Antonio Ascione25, Antonio Craxì3, Antonio Izzi26
Author information
1Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy.
2Infectious Diseases Unit "S. Anna and San Sebastiano" Hospital, Caserta, Italy.
3Gastroenterology Unit, University of Palermo, Palermo, Italy.
4Internal Medicine Unit, "San Paolo" Hospital Naples, Italy.
5Hepatology Unit, "Villa Betania" Hospital, Naples, Italy.
6Infectious Diseases Unit, "Amedeo di Savoia" Hospital, Turin, Italy.
7Gastroenterology Unit, Pisa University Hospital, Pisa, Italy.
8Hepatology Unit, "A. Cardarelli" Hospital, Naples, Italy.
9Infectious Diseases Unit Umberto Primo Hospital, Siracuse, Italy.
10Ospedale di Ostuni, Ostuni, Italy.
11Infectious Diseases Unit, Policlinico San Matteo, Pavia, Italy.
12Internal Medicine Unit "Santo Spirito" Hospital, Pescara, Italy.
13Hepatology and Gastroenterology Unit, "Santa Maria" Hospital, Terni, Italy.
14Infectious Diseases Unit, "Santa Caterina Novella" Hospital, Galatina, Italy.
15Infectious Diseases-Hepatology Unit, "Lazzaro Spallanzani" Hospital, Rome, Italy.
16Infectious Diseases Unit "Santo Spirito" Hospital, Pescara, Italy.
17Infectious Disease Unit, Maggiore Hospital, Modica, Italy.
18UOC Medical Pathology Unit, University of Sassari, Italy.
19Infectious Diseases Unit, "A. Pugliese" Hospital, Catanzaro, Italy.
20Infectious Diseases Unit, Garibaldi-Nesima Hospital, Catania, Italy.
21Internal Medicine Unit, "San Paolo" Hospital, Civitavecchia, Italy.
22Internal Medicine, University "Campus Biomedico," Rome, Italy.
23Infectious Disease Unit, Civico Hospital, Palermo, Italy.
24Hepatology Unit, Internal Medicine Department, Pozzuoli, Italy.
25Centre for Liver Disease, "Buon Consiglio- Fatebenefratelli" Hospital, Naples, Italy.
26Department of Emergency Infectious Diseases and Infectious Diseases "D. Cotugno" Hospital, Naples, Italy.
Abstract
Introduction: We assessed the performance of direct-acting antivirals (DAAs) in hepatitis C virus (HCV)-infected people who use drugs (PWUDs) in terms of sustained virological response (SVR) and adherence rates in comparison to a location-matched cohort of non-PWUD HCV patients.
Methods: All consecutive HCV RNA-positive PWUDs were enrolled between 2015 and 2019. All subjects underwent DAA treatment according to international guidelines and then followed, at least, up to 12 weeks after the end of treatment (SVR12). The SVR and adherence to treatment was compared with that of non-PWUD HCV patients observed at hepatological units of the CLEO platform. Intention-to-treat analysis was performed.
Results: A total of 1,786 PWUDs who were followed up were available for assessment. Most PWUDs (85.4%) were managed inside the specialized outpatient addiction clinics (SerDs). The overall SVR rate was 95.4%. The SerDs group achieved an SVR rate of 96.2% compared with 91.6% of the non-SerDs group (P < 0.001). Comparison with the non-SerDs group and the control HCV group showed a significant difference in the dropout rate (0.6% in the SerDs group versus 2.8% in the non-SerDs group and 1.2% in the control group; P < 0.001). At multivariate analysis, factors independently associated with SVR were use of the most recent regimens (elbasvir/grazoprevir, glecaprevir/pibrentasvir, and sofosbuvir/velpatasvir; odds ratio: 3.126; P = 0.000) and belonging to the SerDs group (odds ratio: 2.356; P = 0.002).
Discussion: The performance of DAAs in PWUD is excellent, if 2 conditions are met: (i) that the latest generation drugs are used and (ii) that the patients are managed within the SerDs.