Hepatitis C Treatment Outcomes in People Actively Using Drugs in Dallas, Texas

Background: Despite current AASLD/IDSA guidelines recommending treatment in all patients with chronic hepatitis C (HCV) infection with direct acting antivirals (DAA), state Medicaid programs highly restrict access in persons with recent history of illicit drug use. Programs cite concerns for poorer outcomes or higher reinfection rates. Our study describes the real world HCV treatment outcomes in people actively using drugs.

Methods: A retrospective chart review was conducted of patients who initiated treatment for chronic HCV between February 2014 and December 2015 at two Ryan White funded clinics in Dallas, Texas. Active drug use was defined as documented use within 6 months of starting HCV treatment. Outcomes, including completion of therapy and SVR-12, were compared between active drug users and non-drug users by Fisher’s exact test.

Results: Sixty-four patients initiated HCV treatment with interferon-free DAAs: 62/64 (97%) were HIV-positive, 29/64 (45%) had a fibrosis score of ≥ F3 by non-invasive testing, 56/64 (88%) were treatment-naïve, and 31/64 (48%) received HCV medication through patient assistance programs. The majority of patients had HCV genotype 1a (41/64, 64%) or 1b (13/64, 20%). Active drug use was documented in 41% of patients (N=26), injection drug use in 11% of patients (N=7). Drug use, in some cases polysubstance, consisted primarily of marijuana (14/26, 54%), methamphetamine (10/26, 38%), and cocaine (5/26, 19%). At the time of review, 48 patients had passed their therapy completion date. Of these, 20/20 (100%) active drug users and 26/28 (93%) non-drug users successfully completed therapy (p=0.5). Two non-drug users discontinued therapy early due to side effects. At the time of review, 37 patients had passed their SVR-12 date. Of these, 12/15 (80%) active drug users and 19/22 (86%) non-drug users achieved SVR-12 (p=0.8). The overall rate of SVR-12 was 31/37 (84%). There were 3 failures due to relapse, and 3 patients lost to follow up. There was no evidence of HCV reinfection.

Conclusion: Patients with active drug use can achieve high rates of HCV therapy completion and SVR-12. Restrictions implemented by state Medicaid programs, which exclude such patients from receiving HCV treatment, are likely not justified.