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J Addict Med. 2018 Sep/Oct;12(5):346-352. doi: 10.1097/ADM.0000000000000415.

Integrated Care for the Use of Direct-acting Antivirals in Patients With Chronic Hepatitis C and Substance Use Disorder.

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Service d'addictologie, Hôpitaux Universitaires Henri Mondor, APHP, Université Paris-Est, Créteil, France (J-BT); Service d'hépato-gastroentérologie, Hôpital Intercommunal, Créteil, France (CB); Service de pharmacie, Hôpitaux Universitaires Henri Mondor, APHP, Université Paris-Est, Créteil, France (HC); Centre Epice, Créteil, France (DC); CSAPA EGO, Association Aurore, Paris, France (AB); Centre Nova Dona, Paris, France (MB); Service d'hépatologie, Hôpital Henri Mondor, APHP, Université Paris-Est, Créteil, France (MF, FR-T, CH); Service de pharmacie, Hôpital Henri Mondor, APHP, Université Paris-Est, Créteil, France (WK-M); Service de pharmacie, Hôpital Intercommunal, Créteil, France (RC); and INSERM U955, Créteil, France (CH).



Since little is currently known about predictors of response to direct-acting antiviral agents (DAAs) in people who inject drugs, we undertook an analysis of patients attending a hepatitis clinic with addiction services (outpatient clinics and inpatient services) to examine the outcomes associated with the treatment of difficult-to-manage patients with substance use. Our experience was based on integrated care.


A retrospective analysis was undertaken of 50 patients with hepatitis C virus (HCV) and a history of addiction who received treatment with DAAs, according to European guidelines. These regimens were sofosbuvir/ledipasvir for 8 weeks (n = 3), sofosbuvir/ledipasvir ± ribavirin for 12 weeks (n = 19), sofosbuvir/daclatasvir for 12 weeks (n = 20), sofosbuvir/simeprevir (n = 1), or sofosbuvir/daclatasvir for 24 weeks (n = 7). Characteristics of patients who did versus did not achieve a sustained virologic response (SVR) 12 weeks after treatment were compared by univariate analysis.


Forty-two patients (84%) were male; mean age was 46.2 ± 7.3 years. Genotypes were 1 (n = 21), 2 (n = 4), 3 (n = 18), 4 (n = 6), or 6 (n = 1). Most patients were treatment-naïve (n = 38). Five patients had coinfection with human immunodeficiency virus (n = 4) or hepatitis B (n = 1), 28 (56%) had evidence of cirrhosis on FibroScan (>12.5 kPa), and 34 (68%) were receiving opioid substitution therapy. Psychiatric disease, illicit drug use, unemployment, and homelessness/precarious housing were common. Forty-five patients (90%) achieved SVR, 2 were lost to follow-up, and 3 had treatment relapse.


SVR was not significantly associated with sociodemographic or virological characteristics, treatment, social environment, alcohol/drug use, and adherence. Although adherence was slightly worse than in "usual" patients, it did not affect the SVR rate. In these difficult-to-manage patients with HCV and substance use disorder, the real-world SVR rate (90%) was similar to that in nonaddicted populations.

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