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Foschi FG, Borghi A, Grassi A, Lanzi A, Speranza E, Vignoli T, Napoli L, Olivoni D, Sanza M, Polidori E, Greco G, Bassi P, Cristini F, Ballardini G, Altini M, Conti F. Model of Care for Microelimination of Hepatitis C Virus Infection among People Who Inject Drugs. J Clin Med 2021; 10:jcm10174001. [PMID: 34501448 PMCID: PMC8432451 DOI: 10.3390/jcm10174001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 08/30/2021] [Accepted: 08/31/2021] [Indexed: 12/31/2022] Open
Abstract
Background: People who inject drugs (PWID) are the largest group at risk for HCV infection. Despite the direct acting antivirals (DAA) advancements, HCV elimination has been hindered by real-life difficulties in PWID. Aims: This study aimed to assess the impact of a multidisciplinary intervention strategy where HCV screening, treatment and follow-up were performed at the same location on efficacy and safety of DAA-therapy in real-life PWID population. Methods: All HCV-infected PWID referred to five specialized outpatient centers for drug addicts (SerDs) in Northern Italy were prospectively enrolled from May 2015 to December 2019. Hepatologists and SerDs healthcare workers collaborated together in the management of PWID inside the SerDs. Sustained virologic response (SVR), safety of treatment, proportion of patients lost to follow-up and reinfection rate were evaluated. Results: A total of 358 PWID started antiviral treatment. About 50% of patients had advanced fibrosis/cirrhosis, 69% received opioid substitution treatment, and 20.7% self-reported recent injecting use. SVR was achieved in 338 (94.4%) patients. Two patients died during treatment; one prematurely discontinued, resulting in a non-responder; twelve were lost during treatment/follow-up; and five relapsed. No serious adverse events were reported. SVR was lower in recent PWID than in former ones (89.2% vs. 95.8%; p = 0.028). Seven reinfections were detected, equating to an incidence of 1.25/100 person-years. Reinfection was associated with recent drug use (OR 11.07, 95%CI 2.10–58.38; p = 0.005). Conclusion: Our embedded treatment model could be appropriate to increase the linkage to care of HCV-infected PWID. In this setting, DAA regimens are well tolerated and highly effective, achieving a lower rate of reinfection.
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Affiliation(s)
| | - Alberto Borghi
- Internal Medicine Department, Faenza Hospital, 48018 Faenza, Italy; (F.G.F.); (A.B.); (L.N.)
| | - Alberto Grassi
- Internal Medicine Department, Rimini Hospital, 47923 Rimini, Italy; (A.G.); (G.B.)
| | - Arianna Lanzi
- Mental Health and Pathological Addictions Department, Addiction Treatment Service of Cesena, 47521 Cesena, Italy; (A.L.); (M.S.)
| | - Elvira Speranza
- Mental Health and Pathological Addictions Department, Addiction Treatment Service of Faenza, 48018 Faenza, Italy;
| | - Teo Vignoli
- Mental Health and Pathological Addictions Department, Addiction Treatment Service of Lugo, 48121 Ravenna, Italy; (T.V.); (D.O.); (G.G.)
| | - Lucia Napoli
- Internal Medicine Department, Faenza Hospital, 48018 Faenza, Italy; (F.G.F.); (A.B.); (L.N.)
| | - Deanna Olivoni
- Mental Health and Pathological Addictions Department, Addiction Treatment Service of Lugo, 48121 Ravenna, Italy; (T.V.); (D.O.); (G.G.)
| | - Michele Sanza
- Mental Health and Pathological Addictions Department, Addiction Treatment Service of Cesena, 47521 Cesena, Italy; (A.L.); (M.S.)
| | - Edoardo Polidori
- Mental Health and Pathological Addictions Department, Addiction Treatment Service of Rimini and Forlì, 47121 Forlì, Italy;
| | - Giovanni Greco
- Mental Health and Pathological Addictions Department, Addiction Treatment Service of Lugo, 48121 Ravenna, Italy; (T.V.); (D.O.); (G.G.)
| | - Paolo Bassi
- Infectious Disease Department, Ravenna Hospital, 48121 Ravenna, Italy;
| | | | - Giorgio Ballardini
- Internal Medicine Department, Rimini Hospital, 47923 Rimini, Italy; (A.G.); (G.B.)
| | - Mattia Altini
- Local Healthcare Authority of Romagna, AUSL Romagna, 48121 Ravenna, Italy;
| | - Fabio Conti
- Internal Medicine Department, Faenza Hospital, 48018 Faenza, Italy; (F.G.F.); (A.B.); (L.N.)
- Correspondence: ; Tel.: +39-0546-601111
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