A large proportion
of patients with chronic hepatitis C virus (HCV) infection in the UK have
co-morbidities, hazardous use of drugs and alcohol and are taking medications
that can potentially interact with HCV direct-acting antivirals (DAAs), according to
research presented to the 2015
AASLD Liver Meeting in San Francisco. The investigators caution that
clinicians “need to be aware” of the potential for interactions when choosing
HCV treatment regimens.
DAAs have transformed
the treatment of HCV and the prognosis of patients living with the infection.
patients with HCV have other serious mental and physical health problems that
require ongoing therapy and a large proportion also use illicit drugs and/or alcohol.
This means there is significant potential for interaction between HCV DAAs,
other therapies, and for some patients, illicit drugs and alcohol. This could
represent a challenge to the scaling-up of HCV therapy in the UK.
To see if this was
the case, investigators from HCV Research UK designed a study involving adult
patients with chronic HCV infection to describe their demographics,
co-morbidities, lifestyle hazards and use of common medications with possible
drug interactions. Data were collected between March 2012 and October 2014 from
59 treatment centres enrolled with the National HCV Research UK Biobank.
A total of 6278
patients were eligible for inclusion. The median age was 52 years. The
majority of patients (85%) were white. Most (59%) were infected with HCV via
injecting drug use (IDU). However, the investigators note this is lower than
the national prevalence, “raising questions about appropriate access to
specialist care among this patient group.” Approximately a quarter of patients
(24%) had cirrhosis. Prevalence of cirrhosis increased with age from 5% among
those under 39 years of age to 37% among the over-60s.
abused drugs and/or alcohol. Heavy drinking was reported by 38% of patients;
54% were smokers; 25% used cannabis. Patients with a history of injecting drug use had a
higher prevalence of alcohol/drug use compared to non-IDU patients (p <
There was a high
prevalence of co-morbidities. The most common were depression (26%), diabetes
(11%), cancers (8%) and HIV co-infection (5%). Prevalence of all these
co-morbidities was higher among IDU vs. non-IDU patients (p < 0.001).
The most commonly
used co-medications were psychotropics such as antidepressants, opioids and
hypnotics (39%), followed by anti-diabetic drugs (9%), immunosuppressants (6%),
statins (5%) and antiretrovirals (5%).
psychotropic drugs was common in all age groups but peaked among those aged
between 40 and 59 years. The over 60s were the age group most likely to be
taking anti-diabetics, immunosuppressants and statins. Use of antiretrovirals
peaked among 40-59 year olds.
Use of all
co-medications was higher among IDUs compared to non-IDUs (p < 0.001).
conclude that there is a high prevalence of co-morbidities among patients with
chronic HCV infection in the UK. A large proportion of patients have
problematic drug/alcohol use, and use of co-medications was also highly
prevalent. Patients with a history of injecting drug use had an especially high prevalence of
co-morbidities, drug and alcohol use and use of prescription medications. The
researchers also commented on the age-related increases in prevalence of
co-morbidity and use of co-medications, which they believe “highlights the
increasing complexity of managing this condition.”