Introduction Despite discovery of direct acting antiviral agents (DAA), a two- three fold increase in hepatitis C virus (HCV) detection/treatment is necessary to reduce the national HCV disease burden. Ninety percent of HCV positive individuals in England are people who inject drugs (PWID) with poor engagement with health services. Our aim was to assess feasibility of non-invasive detection, stratification and treatment of HCV related chronic liver disease (CLD) in the community.
Method Two-year prospective study (Dec 2013–Nov 2015) conducted at a large substance misuse service in SE England. Individuals offered dry blood spot testing (DBST), mobile transient elastography (TE), and HCV treatment (pegylated interferon/ribavirin/telaprevir). Clinically significant hepatic fibrosis: liver stiffness measurement (LSM) ≥7.5 kPa.
Results To date, 165 individuals recruited, mean age 39.8 ± 8.9 yrs, 84.8% male. One hundred and forty-one (85.5%) had history of injecting drug use (IDU) and 143 (86.7%) reported alcohol use. Eighty-three (50.3%) had had a psychiatric diagnosis. Uptake of DBST was 75 (45.5%), main reason for declining being recent prior testing. Overall prevalence of positive serological markers were: HBcAb 28.8% (n = 42), HCV antibody 62.2% (n = 97) and HCV PCR 75.2% (73/97) (genotype 3a 42.8%, 1a 34.3%). Of those with a positive HCV PCR (n = 73), 62 (84.9%) underwent TE, mean LSM being 7.7 ± 6.6. kPa. Twenty-one (33.9%) had LSM ≥7.5 kPa including 13 (21%) with cirrhosis (LSM ≥12 kPa), one of whom had decompensated disease. Of the 73 with a positive HCV PCR none had had prior treatment: fifteen (20.5%) were not treatment candidates (chaotic life style), interferon was inappropriate in 35 (47.9%) with 23 (31.5%) being eligible for interferon based treatment. Thirteen have commenced therapy (nine genotype 3a, three 1a and one 2b), of whom 4 have successfully completed with 8 achieving rapid virological response.
Conclusion This novel community based liver service at a substance service has shown excellent uptake of both DBST and mobile TE amongst PWID, though prevalence of a positive HCV antibody (62.2%) remains high. Additionally, despite a mean age of <40 yrs about a third of PWID have clinically significant HCV related hepatic fibrosis with 1:5 having established cirrhosis. Though community based interferon therapy is feasible in PWID, it is contraindicated in approximately 50% emphasising the urgent need for interferon-free regimens in this vulnerable population.
Disclosure of interest S. Verma Grant/Research Support from: Gilead, Conflict with: Travel grants from Gilead, Abbvie, Roche, BMS and Janssen, M. O’Sullivan Conflict with: salary funded by Gilead, H. Williams: None Declared, A.-M. Jones: None Declared.