Invited Lecture(JSH)
Thu. November 2nd   14:00 - 14:30   Room 1: Kobe International Exhibition Hall No.2 Building Hall (North)
Invited Lecture12
 Recent treatment of HCV-infected individuals with active drug use
Ming-Lung Yu
National Sun Yat-sen University
With the advance of new interferon-free all oral directly-acting antiviral agents (DAA) in 2016, the current pan-genotypic regimens provide very high sustained virologic response (SVR) rates (>98%) and safety profiles. With the remarkable advance, World Health Organization (WHO) set the goal of HCV elimination by 2030. However, the challenges of HCV management among people who inject drugs (PWID) remain in each care cascade. The HCV seroprevalence is much higher in PWID compared to the general population. However, the coverage of the programs toward HCV elimination remains low worldwide due to criminalization, social stigma, and discrimination in PWID population.
In preventing the spreading of HCV infections among PWID, it is urgent to scale up harm reduction programs, such as needle and syringe programs (NSP) and opioid agonist maintenance therapy (OAMT), which have been shown to significantly reduce HCV occurrence among PWID. The WHO supports the expansion of NSP and OAMT services as essential measures. Integration of HCV care into existing harm reduction services has also been found to improve treatment outcomes for PWID.
While the high SVR rates with DAA treatments among PWID, their uptake and adherence to treatment remain lower than non-PWID. Studies suggest that the concurrent initiation of OAMT and DAA treatment improves SVR rates and reduces the risk of opioid overdose. Integrating HCV care into harm reduction services designed for PWID is crucial in improving treatment outcomes and preventing HCV reinfection.
It is also important to tailor services to different key populations within the healthcare system to reduce the risk of HCV reinfection after achieving viral clearance. Continuous engagement in healthcare services, such as HIV clinics or OAMT centers, can help mitigate the risk of reinfection. Services need to address the unique needs of HIV-positive and HIV-negative PWID. Recently, WHO highlights to implement the strategies to facilitate the elimination goal, including decentralization, integration, task sharing, use of point-of-care testing and reflex RNA testing.
In summary, by implementing the strategies of scaling up harm reduction programs, integrating HCV care into existing services, improving access to DAA treatment, and providing tailored support to address the challenges faced by PWID, it is possible to reduce HCV transmission, improve treatment outcomes, and prevent reinfection among PWID.
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