Influencia de los trastornos psiquiátricos y la terapia de sustitución con opiáceos en el tratamiento del virus de la hepatitis c con antivirales de acción directa en usuarios de drogas por vía parenteral / Influence of psychiatric disorders and opioid substitution therapy on hepatitis C treatment with direct-acting antivirals in people who inject drugs

Introducción: La efectividad del tratamiento del virus de la hepatitis C (VHC) parece ser menor en usuarios de drogas por vía parenteral (UDVP). Analizamos la influencia de diversos factores como los trastornos psiquiátricos y la terapia de sustitución con opiáceos (TSO) en el tratamiento con antivirales de acción directa (AAD) de este colectivo.Pacientes y métodos: Trescientos treinta y dos pacientes UDVP fueron tratados con AAD en 12 hospitales de España entre 2004 y 2020. Se catalogaron, si se disponía del dato, en consumidores recientes y pasados (según si el último consumo fue en los últimos 3 años) y se recogieron diversas variables, evaluándose la efectividad del tratamiento según la carga viral 12 semanas tras la finalización del tratamiento con el parámetro «respuesta viral sostenida» (RVS12).Resultados: El 23,4% eran consumidores recientes y el 27,7% estaban en TSO. El 41,5% presentaban algún diagnóstico de enfermedad psiquiátrica. La RVS12 fue del 84,04%, ascendiendo al 96,21% al excluir del análisis a los pacientes que perdieron el seguimiento (12,7%). La RVS12 fue significativamente inferior debido a un aumento de la pérdida de seguimiento en consumidores recientes, aquellos en TSO, los que habían estado en prisión los últimos 5 años y pacientes naïve, así como en el trastorno de ansiedad generalizada y consumidores de benzodiacepinas.Conclusiones: La efectividad del tratamiento del VHC con AAD en UDVP es similar a la población general si se consigue un adecuado seguimiento. Es importante realizar un seguimiento más estrecho en pacientes en TSO, consumidores recientes y aquellos con enfermedad psiquiátrica.(AU)

Introduction: The effectiveness of the hepatitis C virus (HCV) treatment seems to be lower in people who inject drugs (PWID). We analyze the influence of various factors as psychiatric disorders and opioid substitution therapy (OST) on the treatment with direct-acting antivirals (DAA) in this collective.Patients and methods: Three hundred thirty-two PWID patients were treated with DAA in 12 Spanish hospitals between 2004 and 2020. They were catalogued in recent and former consumers (if the last consumption was in the last 3 years) and several variables were included, evaluating the effectiveness of the treatment according to the viral load 12 weeks after the end of the treatment with the parameter «sustained viral response» (SVR12).Results: 23.4% were recent consumers and 27.7% were on OST. The 41.5% had any diagnosis of psychiatric disorder. SVR12 was 84.04%, ascending to 96.21% when excluded from the analyses the patients lost to follow-up (12.7%). SVR12 was lower due to an increase in the loss to follow-up in recent consumers and other factors like OST, being in prison the last 5 years, naïve patients, generalized anxiety disorder and benzodiazepine consumption.Conclusions: The effectiveness of the HCV treatment with DAA in PWID is similar than in general population in patients whit an appropriate follow-up. It is important to maintain a closer follow-up in patients on OST, recent consumers and those with psychiatric disorders.(AU)

Influence of psychiatric disorders and opioid substitution therapy on hepatitis C treatment with direct-acting antivirals in people who inject drugs. / Influencia de los trastornos psiquiátricos y la terapia de sustitución con opiáceos en el tratamiento del virus de la hepatitis c con antivirales de acción directa en usuarios de drogas por vía parenteral.

INTRODUCTION: The effectiveness of the hepatitis C virus (HCV) treatment seems to be lower in people who inject drugs (PWID). We analyze the influence of various factors as psychiatric disorders and opioid substitution therapy (OST) on the treatment with direct-acting antivirals (DAA) in this collective. PATIENTS AND METHODS: Three hundred thirty-two PWID patients were treated with DAA in 12 Spanish hospitals between 2004 and 2020. They were catalogued in recent and former consumers (if the last consumption was in the last 3 years) and several variables were included, evaluating the effectiveness of the treatment according to the viral load 12 weeks after the end of the treatment with the parameter «sustained viral response¼ (SVR12). RESULTS: 23.4% were recent consumers and 27.7% were on OST. The 41.5% had any diagnosis of psychiatric disorder. SVR12 was 84.04%, ascending to 96.21% when excluded from the analyses the patients lost to follow-up (12.7%). SVR12 was lower due to an increase in the loss to follow-up in recent consumers and other factors like OST, being in prison the last 5 years, naïve patients, generalized anxiety disorder and benzodiazepine consumption. CONCLUSIONS: The effectiveness of the HCV treatment with DAA in PWID is similar than in general population in patients whit an appropriate follow-up. It is important to maintain a closer follow-up in patients on OST, recent consumers and those with psychiatric disorders.