Treatment with direct‐acting antiviral agents of hepatitis C virus infection in injecting drug users: A prospective study

Summary In this prospective study, we evaluated the effectiveness and tolerability of novel therapies against hepatitis C virus ( HCV ) in a cohort of PWID enrolled at our centre from April 2015 to July 2016. In this analysis, a total of 174 patients were included: eleven (6.3%) were treated with pegylated interferon ( PEG ‐ IFN ) and ribavirin ( RBV ) containing regimens, 163 (93.7%) with IFN ‐free treatments. RBV has been used in 70 patients (40.2%); 59 (33.9%) patients were in opioid substitution therapy ( OST ) with methadone or buprenorphine. Overall, sustained virological response ( SVR ) has been observed in 162 subject (93.1%), breakthrough ( BT ) in three (1.7%), relapse in one (0.6%) and dropout in eight (4.6%). Treatment was interrupted for clinical conditions in seven patients: six (3.4%) had hepatic decompensation and one died for hepatocellular carcinoma ( HCC ). In multivariate analysis, predictive factors of treatment failure were as follows: albumin level below 3 g/ dL ( OR =7.190; 95% IC =1.236‐41.837; P <.001), MELD score >10 ( OR =5.886; 95% IC =1.411‐35.994; P <.001) and years of HCV infection >20 ( OR =1.286; 95% IC =0.556‐9.455; P= .016). In conclusion, treatment with DAA s was effective and well tolerated in PWID ; cirrhotic subjects with MELD  > 10 and albumin low level showed a higher risk of developing serious adverse events and treatment failure.