Copyright
©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
Hepatitis C virus burden: Treating and educating people without prejudice
Elettra Merola, Elisa Menotti, Giovanna Branz, Andrea Michielan, Sonia Seligmann, Annora Ratti, Flora Agugiaro, Luisa Moser, Giovanni Vettori, Anna Franceschini, William Mantovani, Riccardo Pertile, Giovanni de Pretis, Cecilia Pravadelli
Elettra Merola, Elisa Menotti, Andrea Michielan, Sonia Seligmann, Flora Agugiaro, Luisa Moser, Giovanni Vettori, Giovanni de Pretis, Cecilia Pravadelli, Department of Gastroenterology, Santa Chiara Hospital, Azienda Provinciale Per I Servizi Sanitari (APSS), Trento 38122, Italy
Giovanna Branz, Annora Ratti, Anna Franceschini, Department of SerD, Service for Drug Addiction, Azienda Provinciale Per I Servizi Sanitari (APSS), Trento 38122, Italy
William Mantovani, Department of Prevention, Azienda Provinciale Per I Servizi Sanitari (APSS), Trento 38122, Italy
Riccardo Pertile, Department of Clinical and Evaluative Epidemiology, Azienda Provinciale Per I Servizi Sanitari (APSS), Trento 38122, Italy
Author contributions: Elettra E and Menotti E shared the first authorship; Pravadelli C, Branz G, and Merola E designed the research and served as guarantors; Menotti E, Seligmann S, and Branz G participated in the data acquisition; Merola E, Pravadelli C, and Pertile R participated in the data analysis; all the authors participated in the interpretation of the data; Merola E, Menotti E, Pravadelli C, Branz G, and Michielan A drafted the initial manuscript; all the authors participated in a critical review of the article’s important intellectual content and approved the final version.
Institutional review board statement: In accordance with local legislation, the study protocol was approved by the local ethical committee (N. A785), and informed consent was obtained from patients for data acquisition.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All authors declare that they have no conflict of interest.
Data sharing statement: Participants gave informed consent for data sharing
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Andrea Michielan, MD, Doctor, Department of Gastroenterology, Santa Chiara Hospital, Azienda Provinciale Per I Servizi Sanitari, Largo Medaglie D'oro 8, Trento 38122, Italy. andrea.michielan@apss.tn.it
Received: April 3, 2022
Peer-review started: April 3, 2022
First decision: May 12, 2022
Revised: May 26, 2022
Accepted: June 22, 2022
Article in press: June 22, 2022
Published online: July 27, 2022
BACKGROUND
Hepatitis C virus (HCV) infection has a worldwide incidence of 1.1%. In Italy, 60% of people who inject drugs (PWIDs) and are receiving assistance for substance use disorder are infected with HCV. However, this subset of patients has extremely limited access to care due to multiple factors, including alcohol abuse, psychological comorbidities, and homeless status.
AIM
To describe the impact of our HCV-dedicated service for substance use disorder (SSUD) service on PWIDs receiving anti-HCV therapy.
METHODS
A dedicated, multidisciplinary team was set up at the SSUD of Trento in October 2020 to provide antiviral treatment to HCV RiboNucleic Acid-positive patients with an active or previous history of substance abuse. The treatment was followed by a health education program. Patients were treated with Direct-Acting Antivirals (DAAs). Data were retrospectively analyzed to assess the efficacy of our dedicated program in terms of therapy completion, HCV eradication, and compliance (primary endpoint). The rate of HCV reinfection and DAA-related toxicity were also assessed (secondary endpoints).
RESULTS
A total of 40 patients were enrolled in the study: 28 (70.0%) were treated with Sofosbuvir/Velpatasvir, while 12 (30.0%) received Glecaprevir/Pibrentasvir. At the time of inclusion in the study, 36 patients were receiving opioid agonist maintenance therapy, whilst another 4 had just finished the treatment. 37.5% had a history of alcoholism and 42.5% received concomitant psychiatric treatment. All 40 patients (100.0%) completed the therapy cycle and 92.5% of patients adhered to the program. All patients tested negative for viral load at the end of the treatment. There were no significant drug interactions with common psychiatric treatments and no side effects were observed. The sustained virological response was achieved in 92.5% of cases with good tolerability, although two patients discontinued treatment temporarily. After HCV eradication, one patient died from an overdose, another from complications of cirrhosis, and one reinfection occurred.
CONCLUSION
Very high adherence to therapy and good tolerability was observed in our series of HCV patients treated at the SSUD, regardless of the substance abuse condition. Further validation in a larger population is required.
Core Tip: Hepatitis C virus (HCV) infection has an incidence of 1.1%, reaching 60% in Italy among people who inject drugs. This paper reports the impact of our HCV-dedicated program to provide antiviral treatment to HCV patients with a history of substance abuse. 40 patients were treated with direct-acting antivirals: 38 were receiving opioid agonist maintenance therapy, and 4 had just finished this treatment. 37.5% had a history of alcoholism, and 42.5% received concomitant psychiatric treatment. The therapy cycle was completed in all patients, and 92.5% adhered to post-therapy controls. All patients were HCV RNA-negative at the end of treatment, with a sustained virological response of 92.5%.
