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HCV microelimination in harm reduction centres has benefits beyond HCV cure but is hampered by high reinfection rates

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dc.contributor.author Lens, Sabela
dc.contributor.author Miralpeix, Anna
dc.contributor.author Gálvez, Mont
dc.contributor.author Martró, Elisa
dc.contributor.author González, Noemi
dc.contributor.author Rodríguez-Tajes, Sergio
dc.contributor.author Mariño, Zoe
dc.contributor.author Saludes, Verónica
dc.contributor.author Reyes-Urueña, Juliana
dc.contributor.author Majó, Xavier
dc.contributor.author Colom, Joan
dc.contributor.author Forns, Xavier
dc.date.accessioned 2023-04-13T06:23:33Z
dc.date.available 2023-04-13T06:23:33Z
dc.date.issued 2022
dc.identifier.citation Lens S, Miralpeix A, Gálvez M, Martró E, González N, Rodríguez-Tajes S, Mariño Z, Saludes V, Reyes-Urueña J, Majó X, Colom J, Forns X. HCV microelimination in harm reduction centres has benefits beyond HCV cure but is hampered by high reinfection rates. JHEP Rep. 2022 Sep 13;4(12):100580. DOI: 10.1016/j.jhepr.2022.100580
dc.identifier.issn 2589-5559
dc.identifier.uri http://hdl.handle.net/10230/56456
dc.description.abstract Background & aims: Significant scale-up of treatment among people who inject drugs (PWID) is crucial to achieve WHO HCV elimination targets. We explored the impact of on-site HCV diagnosis and treatment on PWID in an externalised hepatology clinic at the biggest harm reduction centre (HRC) in Barcelona attending to a marginalised PWID population with ongoing high-risk practices. Methods: On-site HCV point-of-care testing was performed for diagnosis and treatment delivery. HCV-RNA was assessed at SVR12 (sustained virologic response at 12 weeks) and every 6 months. The programme included behavioural questionnaires at baseline and after treatment. Results: Between 2018 and 2020, 919 individuals were prospectively enrolled. Of these, only 46% accepted HCV screening. HCV-RNA+ prevalence was 55.7% (n = 234). Of the 168 (72%) individuals starting treatment, 48% were foreigners, 32% homeless, 73% unemployed, and 62% had a history of incarceration. At enrolment, 70% injected drugs daily and 30% reported sharing needles or paraphernalia. Intention-to-treat SVR12 was 60%; only 4% were virological failures, the remaining were either early reinfections (20%) or losses to follow-up (16%). The overall reinfection rate during follow-up was 31/100 persons/year. HIV coinfection and daily injection were associated with a higher risk of reinfection. Nonetheless, beyond viral clearance, antiviral therapy was associated with a significant reduction in injection frequency, risk practices, and homelessness. Conclusions: HCV treatment can be successfully delivered to active PWID with high-risk practices and has a significant benefit beyond HCV elimination. However, approaching this difficult spectrum of the PWID population implies significant barriers such as low rate of screening acceptance and high dropout and reinfection rates. Lay summary: People who inject drugs attending harm reduction centres represent the most difficult population to treat for hepatitis C. We show that hepatitis C treatment has a significant benefit beyond viral cure, including improving quality of life, and decreasing injection frequency and risk practices. However, intrinsic barriers and the high reinfection rates hamper the achievement of viral microelimination in this setting.
dc.format.mimetype application/pdf
dc.language.iso eng
dc.publisher Elsevier
dc.relation.ispartof JHEP Rep. 2022 Sep 13;4(12):100580
dc.rights © 2022 The Author(s). Published by Elsevier B.V. on behalf of European Association for the Study of the Liver (EASL). This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
dc.rights.uri http://creativecommons.org/licenses/by-nc-nd/4.0/
dc.title HCV microelimination in harm reduction centres has benefits beyond HCV cure but is hampered by high reinfection rates
dc.type info:eu-repo/semantics/article
dc.identifier.doi http://dx.doi.org/10.1016/j.jhepr.2022.100580
dc.subject.keyword Antiviral therapy
dc.subject.keyword BP, bodily pain
dc.subject.keyword DAA, direct-acting antivirals
dc.subject.keyword DBS, dried blood spot
dc.subject.keyword DDIs, drug–drug interactions
dc.subject.keyword Dried blood spot testing
dc.subject.keyword Drug users
dc.subject.keyword FU12, 12 weeks of follow-up
dc.subject.keyword GH, general health
dc.subject.keyword HRC, harm reduction centre
dc.subject.keyword Hepatitis C
dc.subject.keyword High-risk practices
dc.subject.keyword LSM, liver stiffness measurement
dc.subject.keyword MCS, mental component summary
dc.subject.keyword MH, mental health
dc.subject.keyword NSPs, needle and syringe programmes
dc.subject.keyword OR, odds ratio
dc.subject.keyword OST, opioid substitution therapy
dc.subject.keyword PCS, physical component summary
dc.subject.keyword PF, physical functioning
dc.subject.keyword PP, per protocol
dc.subject.keyword PWID, people who inject drugs
dc.subject.keyword PoCT, point-of-care testing
dc.subject.keyword RE, role emotional
dc.subject.keyword RP, role physical
dc.subject.keyword SF, social functioning
dc.subject.keyword SVR, sustained virologic response
dc.subject.keyword SVR12, sustained virologic response at 12 weeks
dc.subject.keyword TARGA, antiretroviral therapy
dc.subject.keyword VT, vitality
dc.rights.accessRights info:eu-repo/semantics/openAccess
dc.type.version info:eu-repo/semantics/publishedVersion


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