Directly Acting Antiviral-Based Treatment for HCV-Infected Persons Who Inject Drugs: A Multicenter Real-Life Study.

BACKGROUND: We aimed to evaluate the factors associated with a virological response in a cohort of Hepatitis C virus (HCV)-infected people who inject drugs (PWID) treated with direct acting antivirals (DAAs). METHODS: We conducted a multicenter retrospective cohort study enrolling HCV-infected PWID treated with DAAs. The primary outcome evaluated was the sustained virological response (SVR12) rate. RESULTS: Five hundred and twenty HCV-infected PWID treated with all-oral DAA-based regimens were enrolled; a total of 168 (32.3%) patients presented genotype 1a, 109 (21.0%) genotype 1b, and 174 (33.5%) genotype 3; a total 152 of the 520 subjects (29.2%) were cirrhotics; a total 118 (22.7%) and 373 (71.7%) were treated with DAA regimens of second and third generation, respectively; a total 169 (33.6%) patients were receiving an opioid agonist at the start of antiviral therapy. Only 11 subjects (2.1%) did not show an SVR12. A significant correlation was found between treatment with opioid substitution therapy (p < 0.001), Human Immunodeficiency Virus (HIV) coinfection (p = 0.002), and treatment with first- or second-generation regimens (p = 0.0015) and HCV failure. Upon multivariate analysis, treatment with a first- or second-generation DAA was the only factor independently associated with failure (OR 10.4, 95% CI: 1.43 to 76.1, p = 0.02). CONCLUSIONS: Treatment with DAAs led to a high SVR12 rate (97.9%) in a large cohort of HCV-infected PWID. The only predictor of viral failure found in our analysis was treatment with first- and second-generation DAA.

The Discrimination Against, Health Status and Wellness of People Who Use Drugs in Italian Services: A Survey.

Background and Objectives: The aims of this study are to: describe the sociodemographic characteristics and typology of drug addiction among people who use drugs that attend the Servizio per le Dipendenze (SerD), and evaluate the competence and ability of these rehabilitation services to improve their health status and wellness. Materials and Methods: A cross-sectional study was conducted from January to July 2017. Patients attending two selected SerD facilities in the city of Naples, Italy were interviewed with a questionnaire gathering information on sociodemographic data, characteristics of drug addiction, characteristics of enrolment at the SerD, self-reported health status and wellness, and reports of the discrimination suffered. Results: Among the 451 people interviewed, 72.3% had started taking drugs by the age of 20, and half of them have used drugs within the last year. 54.5% of responders attended SerD for more than 10 years, and the two main reasons for attendance were to get help and to get methadone. 79.4% were declared to have a good/very good/excellent health status at the time of interviewing. 53.7% reported suffering from discrimination. Conclusions: Based on our study, discrimination is higher in participants who attended SerD for more than one year, who were formerly in prison, or who were current drug users.

Epidemiological survey of hepatitis C virus infection in a cohort of patients from a ser.T in naples, Italy.

Hepatitis C virus (HCV) has infected an estimated 170 million people worldwide, most of whom are chronically infected (60% to 80%). In Italy, the estimate of anti-HCV antibody (Ab) prevalence, in the general population of Northern Italy, is 3.2%; in Central and Southern Italy, it is 8.4% to 22.4%. Highest prevalence of infection (70% to 90%) is found among intravenous drug users. Our purpose is to monitor HCV infection among drug users treated in a Drug Addiction Centre (Ser.T) in Naples and to gain a better understanding of that relationship with the abused substance(s). Epidemiological data are shown for viral coinfections. Finally, the authors investigate access to specific HCV therapy in an Italian Ser.T. The study analyzed a group of 1753 consecutive subjects treated from 1988 to 2008 in the O.U. Ser.T D.S.31 (Gesù e Maria Hospital), ASL Napoli 1 Centre. HCV Abs were detected by enzyme immune assay method and confirmed by recombinant immunoblot assay III method. During the entire period, we performed real-time polymerase chain reaction at random for 312 patients. The incidence (per year) of HCV infection showed a rapid spread decrease from 49.5% in 2003 to 14.5% in 2008. The overall prevalence of HCV was 48.1%. We tested 312 randomly selected patients for viral replication. Our study showed active viral replication in 201 (64.4%) patients as follows: 97 of 201 (31.1%) resulted infected by genotype (gt) 1; 3 of 201 (1.0%) gt 2; 84 of 201 (26.9%) gt 3; and 4 of 201 (1.3%) gt 4. Coinfection data showed that HCV Ab prevalence was 58.5% (48 of 82) in hepatitis B virus chronically infected patients. Human immunodeficiency virus (HIV)/HCV coinfection resulted in 95.2% (80 of 84) HIV patients. The prevalence of HIV Abs in HCV-infected patients was 8.99% (80 of 889). Analysis of drug abuse showed high prevalence of opiate addicted, multiabusers, and with high-risk factors. Cocaine abuser prevalence was 14.4%, and incidence, during past 4 years of the study, rose to 42.6%. Alcohol abuser prevalence represented 5.8% of patients and incidence rose to 17.7% in final 4 years of the study. In those opiate addicted, HCV infection was 61.0% (805 of 1320). HCV infection in cocaine-addicted patients was 9.5% (24 of 253). In 78 delta-9-tetra-hydro-cannabinol addicted patients, 5.1% of tests were positive (4 of 78). In alcohol abusers, HCV infection was 9.8% (10 of 102). Access to HCV treatment in our cohort from 2000 to 2008 resulted low (15.4%). Enhancing the Ser.Ts efficiency can result in health and financial benefits.

Together to take care: multidisciplinary management of hepatitis C virus treatment in randomly selected drug users with chronic hepatitis.

Hepatitis C Virus (HCV) infection is treated with peg-interferon α2a or α2b and ribavirin. International studies show that drug user adherence to treatment is 40% to 60% and increases if the patient is in addiction treatment. The aim of the Together To Take Care (TTTC) study was to achieve better adherence to HCV therapy in randomly selected drug users, who are considered "difficult to treat." The secondary aim of the TTTC Study Group was to standardize a method for a multidisciplinary management of the liver disease in drug users. The TTTC group data were matched with a control group. Adherence: The 93.7% of patients followed therapy prescribed; of the patients infected by HCV genotype (gt) 3, all completed therapy as scheduled. For the 48-week treatment group, 66.7% of patients completed therapy (2 of 9 patients stopped treatment for breakthrough). Toxicological results: 10 (62.5%) patients were negative in the toxicological tests (opiates, cocaine, and alcohol). Virological results: 8 of 16 patients were infected by HCV gt 1, and 8 were infected by gt 3; 2 of 16 (12.5%) patients were human immunodeficiency virus (HIV) coinfected (1 HCV gt 1a and 1 HCV gt 3). All patients: 11 of 16 (68.75%) patients were HCV ribonucleic acid undetectable 24 weeks after completing therapy (sustained virological response, SVR). Gt 1: 4 of 8 (50.0%) showed SVR. Gt 3: 7 of 8 (87.5%) showed SVR. Overall, the HCV gt 3 patients had 87.5% probability of SVR, whereas gt 1 patients had 50% probability of SVR (gt 3/gt 1 patients odds ratio = 7). The results were analyzed by Fisher exact test. Our results show that good healthcare management plays an important role in increasing patients' adherence to therapy. In the project "TTTC," the patients work with the physicians to take responsibility for their health and acquire self-efficacy and self-awareness, thanks to the special care.