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. 2023 Aug 4:19:645-656.
doi: 10.2147/TCRM.S409134. eCollection 2023.

Analysis of Patients' Characteristics and Treatment Profile of People Who Use Drugs (PWUDs) with and without a Co-Diagnosis of Viral Hepatitis C: A Real-World Retrospective Italian Analysis

Felice Alfonso Nava  1 , Alessandra Mangia  2 , Marco Riglietta  3 , Lorenzo Somaini  4 , Francesco Giuseppe Foschi  5 , Ernesto Claar  6 , Ivana Maida  7 , Claudio Ucciferri  8 , Francesca Frigerio  9 , Candido Hernandez  10 , Melania Dovizio  11 , Valentina Perrone  11 , Luca Degli Esposti  11 , Massimo Puoti  12
Affiliations

Analysis of Patients' Characteristics and Treatment Profile of People Who Use Drugs (PWUDs) with and without a Co-Diagnosis of Viral Hepatitis C: A Real-World Retrospective Italian Analysis

Felice Alfonso Nava et al. Ther Clin Risk Manag. .

Abstract

Purpose: Hepatitis C virus (HCV) spreads from contact with blood of an infected person. HCV infections are common among people who use drugs (PWUDs), when sharing needles, syringes, or other equipment for injected drugs. The advent of pangenotypic direct-antiviral agents (DAA) in 2017 transformed the treatment landscape for HCV, but PWUDs remain a complex and hard-to-treat population with high risk of HCV reinfection. The aim of this real-world analysis was to characterize the demographic and clinical features of PWUDs in Italy, also focusing on comorbidity profile, treatment with DAAs, resource consumptions for the National Health System (NHS).

Patients and methods: During 01/2011-06/2020, administrative databases of Italian healthcare entities, covering 3,900,000 individuals, were browsed to identify PWUDs with or without HCV infection. Among HCV+ patients, a further stratification was made into treated and untreated with DAAs. The date of PWUD or HCV first diagnosis or DAA first prescription was considered as index-date. Patients were then followed-up for one year. Alcohol-dependency was also investigated.

Results: Total 3690 PWUDs were included, of whom 1141 (30.9%) PWUD-HCV+ and 2549 (69.1%) PWUD-HCV-. HCV-positive were significantly older (43.6 vs 38.5 years, p < 0.001), had a worse comorbidity profile (Charlson-index: 0.8 vs 0.4, p < 0.001), and high rates of psychiatric, respiratory, dermatological, musculoskeletal diseases and genitourinary (sexually transmitted) infections. Moreover, they received more drug prescriptions (other than DAAs, like anti-acids, antiepileptics, psycholeptics) and had undergone more frequent hospitalization, predominantly for hepatobiliary, respiratory system and mental disorders. DDA-untreated had significantly higher Charlson-index than DAA-treated (0.9 vs 0.6, p = 0.003). Alcoholism was found in 436 (11.8%) cases.

Conclusion: This Italian real-world analysis suggests that PWUDs with HCV infection, especially those untreated with DAAs, show an elevated drug consumption due to their complex clinical profile. These findings could help to ameliorate the healthcare interventions on PWUDs with HCV infection.

Keywords: alcohol dependency; drug abuse; hepatitis C virus; real-world evidence.

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Conflict of interest statement

A.M. declares teaching and speaking and research support: Angelini, Gilead Sciences, Polifarma. F.F and C.H are employees of Gilead Sciences. M.P. reports grants, personal fees, non-financial support from Gilead, AbbVie; personal fees from Merck, during the conduct of the study; personal fees from Angelini, Astra Zeneca, GSK, Menarini, Janssen, Roche, and Novartis, outside the submitted work. All other authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Flow-chart reporting study population identification and derived cohorts: (A) study on the overall inclusion period; (B) study on the inclusion period divided into before and after 2017.
Figure 2
Figure 2
Treatment evaluation in overall PWUD patients and in those stratified by the HCV co-diagnosis during the first year of follow-up: distribution according to the drug ATC first level identification code (excluding DAAs).
Figure 3
Figure 3
Treatments evaluation in overall PWUD patients and in those stratified by the HCV co-diagnosis during the first year of follow-up: distribution according to the drug ATC second level identification code (excluding DAAs).
See this image and copyright information in PMC

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