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. 2024 Nov:133:104616.
doi: 10.1016/j.drugpo.2024.104616. Epub 2024 Oct 24.

Predictors of treatment outcomes for Hepatitis C infection in a nationwide elimination program in Iceland: The treatment as prevention for Hepatitis C (TraP HepC) study

Sigurdur Olafsson  1 , Thorvardur Jon Love  2 , Ragnheidur Hulda Fridriksdottir  3 , Thorarinn Tyrfingsson  4 , Valgerdur Runarsdottir  4 , Ingunn Hansdottir  5 , Ottar Mar Bergmann  3 , Einar Stefan Björnsson  6 , Birgir Johannsson  7 , Bryndis Sigurdardottir  7 , Arthur Löve  8 , Guðrún Erna Baldvinsdottir  9 , Marianna Thordardottir  10 , Ubaldo Benitez Hernandez  11 , Maria Heimisdottir  12 , Margaret Hellard  13 , Magnus Gottfredsson  14 ; TraP Hep C working group
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Free article

Predictors of treatment outcomes for Hepatitis C infection in a nationwide elimination program in Iceland: The treatment as prevention for Hepatitis C (TraP HepC) study

Sigurdur Olafsson et al. Int J Drug Policy. 2024 Nov.
Free article

Abstract

Background: Limited data exists about treatment outcomes in nationwide hepatitis C virus (HCV) elimination programs where injection drug use (IDU) is the main mode of transmission. In 2016 Iceland initiated the HCV elimination program known as Treatment as Prevention for Hepatitis C (TraP HepC). Factors associated with HCV cure in this population are examined.

Methods: Unrestricted access was offered to direct acting antiviral agents (DAAs). Testing and harm reduction was scaled up and re-treatments were offered for those who did not attain cure. Cure rates for the first 36 months were assessed and factors associated with failure to achieve cure analysed using multivariable logistic regression.

Results: Treatment was initiated for 718; 705 consented for the study. Median age was 44 years (IQR 35-56), history of IDU reported by 593 (84.1 %), recent IDU by 234 (33.2 %); 48 (6.8 %) were homeless. Of 705 patients, 635 achieved cure (90.1 %) during the first treatment. A total of 70 (9.9 %) patients initiated two or more treatments, resulting in 673 participants cured (95.5 %). By multivariable analysis, homelessness was the only statistically significant independent factor associated with not achieving cure (OR 2.67, 95 % CI 1.32-5.41) after first treatment attempt.

Conclusion: By reengagement in care and prompt retreatment when needed, a cure rate of 95.5 % was achieved. Unstable housing, a potentially actionable factor is associated with poor outcome.

Keywords: Direct acting antivirals; Hepatitis C virus elimination; Hepatitis C virus infection; Injection drug use.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: SO, MG, RHF, and VR report consultancy and speaker's fees from Gilead Sciences. MHel's institute receives funding from Gilead Sciences and AbbVie for investigator-initiated research on which MHel is a chief investigator. All other authors declare no competing interests.

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