Due in part to the high prices direct-acting antivirals for hepatitis C infection, many Medicaid programs are not offering them to injection drug users, nor are some states and institutions seeking these patients out for testing to see if they have the virus.
But a new study shows that even when drug-users do not give up their habit, they can be treated for the lethal virus.
Injection-drug users with hepatitis C genotypes 1, 4 and 6 did well on a fixed-dose combination of grazoprevir and elbasvir, Alain Litwin, MD, of Montefiore Medical Center in the Bronx, NY and colleagues reported at the Liver Meeting (AASLD) in San Francisco, CA.
That included patients who were co-infected with HIV. These patients were also getting opioid agonists (methadone and buprenorphine). They were screened for illicit drug use, but abstinence was not a condition for being in the study.
The double-blind, placebo-controlled study randomized 301 patients (two-to-one) to an immediate treatment group or a deferred treated group. The deferred group got a placebo for 12 weeks, then 12 weeks of the drug combo. The endpoint was sustained viral response at follow-up week 12.
In the overall group, drug use was high. Seventy-nine percent were getting methadone 21% were getting buprenorphine. In the immediate treatment group, 79% were drug users. Of those, 16% were using amphetamines, 39% were taking benzodiazepines, 39% marijuana, 40% cocaine, and 41% opioids.
Despite their continued drug use during treatment, 96% of those getting the study drug combo achieved sustained viral response 4.
Adverse events were common but not severe and included fatigue, headache, and nausea.
The study shows that patients who are actively using drugs can get effective treatment for HCV infection. That finding “supports enhanced efforts to address barrier to HCV treatment access in persons who inject drugs,” the researchers concluded.