Prospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 14, 2022; 28(2): 263-274
Published online Jan 14, 2022. doi: 10.3748/wjg.v28.i2.263
Outreach onsite treatment with a simplified pangenotypic direct-acting anti-viral regimen for hepatitis C virus micro-elimination in a prison
Chun-Ting Chen, Ming-Ying Lu, Meng-Hsuan Hsieh, Pei-Chien Tsai, Tsai-Yuan Hsieh, Ming-Lun Yeh, Ching-I Huang, Yi-Shan Tsai, Yu-Min Ko, Ching-Chih Lin, Kuan-Yu Chen, Yu-Ju Wei, Po-Yao Hsu, Cheng-Ting Hsu, Tyng-Yuan Jang, Ta-Wei Liu, Po-Cheng Liang, Ming-Yen Hsieh, Zu-Yau Lin, Chung-Feng Huang, Jee-Fu Huang, Chia-Yen Dai, Wan-Long Chuang, Yu-Lueng Shih, Ming-Lung Yu
Chun-Ting Chen, Yu-Lueng Shih, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tri-Service General Hospital Penghu Branch, National Defense Medical Center, Penghu County 88041, Taiwan
Chun-Ting Chen, Tsai-Yuan Hsieh, Yu-Lueng Shih, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan
Ming-Ying Lu, Meng-Hsuan Hsieh, Pei-Chien Tsai, Ming-Lun Yeh, Ching-I Huang, Yi-Shan Tsai, Yu-Min Ko, Ching-Chih Lin, Kuan-Yu Chen, Yu-Ju Wei, Po-Yao Hsu, Cheng-Ting Hsu, Tyng-Yuan Jang, Ta-Wei Liu, Po-Cheng Liang, Ming-Yen Hsieh, Zu-Yau Lin, Chung-Feng Huang, Jee-Fu Huang, Chia-Yen Dai, Wan-Long Chuang, Ming-Lung Yu, Division of Hepatobiliary, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan
Meng-Hsuan Hsieh, Ming-Lun Yeh, Ching-I Huang, Yi-Shan Tsai, Yu-Min Ko, Ching-Chih Lin, Kuan-Yu Chen, Yu-Ju Wei, Po-Yao Hsu, Cheng-Ting Hsu, Tyng-Yuan Jang, Ta-Wei Liu, Po-Cheng Liang, Ming-Yen Hsieh, Zu-Yau Lin, Chung-Feng Huang, Jee-Fu Huang, Chia-Yen Dai, Wan-Long Chuang, Ming-Lung Yu, School of Medicine and Hepatitis Research Center, College of Medicine, and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
Ming-Lung Yu, National Pingtung University of Science and Technology, Pingtung 912, Taiwan
Author contributions: Chen CT and Yu ML drafted the manuscript; Tsai PC and Hsieh MH assisted with data collection and analysis; Yu ML and Shih YL made equal contributions; all authors participated in universal mass screening, immediate onsite treatment, read and approved the final manuscript.
Supported by the Kaohsiung Medical University, No. 108-2314-B-037-066 and No. DK107004; and the Kaohsiung Medical University Hospital, No. KMUH-108-8R05, No. KMUH-DK109002 and No. KMUH-DK109005-1.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Kaohsiung Medical University Hospital (IRB: KMUHIRB-SV(I)-20190033) and the Institutional Review Board of Tri-Service General Hospital (IRB: TSGHIRB 2-107-05-080).
Conflict-of-interest statement: No author had reported a potential conflict of interest relevant to this work.
Data sharing statement: There is no additional data available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ming-Lung Yu, MD, PhD, Adjunct Professor, Chief Doctor, Full Professor, Division of Hepatobiliary, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital, No. 100 Shin-Chuan 1st Road, Sanmin District, Kaohsiung 80708, Taiwan. fish6069@gmail.com
Received: August 5, 2021
Peer-review started: August 5, 2021
First decision: November 7, 2021
Revised: November 17, 2021
Accepted: December 31, 2021
Article in press: December 31, 2021
Published online: January 14, 2022
Abstract
BACKGROUND

Prisoners are at risk of hepatitis C virus (HCV) infection, especially among the people who inject drugs (PWID). We implemented an outreach strategy in combination with universal mass screening and immediate onsite treatment with a simplified pan-genotypic direct-acting antivirals (DAA) regimen, 12 wk of sofosbuvir/velpatasvir, in a PWID-dominant prison in Taiwan.

AIM

To implement an outreach strategy in combination with universal mass screening and immediate onsite treatment with a simplified pan-genotypic DAA regimen in a PWID-dominant prison in Taiwan.

METHODS

HCV-viremic patients were recruited for onsite treatment program for HCV micro-elimination with a pangenotypic DAA regimen, 12 wk of sofosbuvir/ velpatasvir, from two cohorts in Penghu Prison, either identified by mass screen or in outpatient clinics, in September 2019. Another group of HCV-viremic patients identified sporadically in outpatient clinics before mass screening were enrolled as a control group. The primary endpoint was sustained virological response (SVR12, defined as undetectable HCV ribonucleic acid (RNA) 12 wk after end-of-treatment).

RESULTS

A total of 212 HCV-viremic subjects were recruited for HCV micro-elimination campaign; 91 patients treated with sofosbuvir/Ledipasvir or glecaprevir/ pibrentasvir before mass screening were enrolled as a control. The HCV micro-elimination group had significantly lower proportion of diabetes, hypertension, hyperlipidemia, advanced fibrosis and chronic kidney diseases, but higher levels of HCV RNA. The SVR12 rate was comparable between the HCV micro-elimination and control groups, 95.8% (203/212) vs 94.5% (86/91), respectively, in intent-to-treat analysis, and 100% (203/203) vs 98.9% (86/87), respectively, in per-protocol analysis. There was no virological failure, treatment discontinuation, and serious adverse event among sofosbuvir/velpatasvir-treated patients in the HCV micro-elimination group.

CONCLUSION

Outreach mass screening followed by immediate onsite treatment with a simplified pangenotypic DAA regimen, sofosbuvir/velpatasvir, provides successful strategies toward HCV micro-elimination among prisoners.

Keywords: Direct-acting antivirals, Sofosbuvir, Velpatasvir, People who inject drugs, Universal screen

Core Tip: We implemented an outreach strategy in combination with universal mass screening and immediate onsite treatment with a simplified pangenotypic direct-acting antivirals egimen, 12 wk of sofosbuvir/velpatasvir, in a people who inject drugs (PWID)-dominant prison. Our study achieved high sustained virological response rate in HCV-infected PWID-dominant prisoners. We provided successful strategies toward HCV micro-elimination among prisoners.