Improved health-related quality of life after hepatitis C viraemic clearance among people who inject drugs may not be durable

Background and Aims: Chronic infection with the hepatitis C virus (HCV) has a detrimental impact on health-related quality of life (QoL). Scale-up of HCV direct-acting antiviral (DAA) therapy among people who inject drugs (PWID) is underway in several countries since the introduction of interferon-free regimens. This study aimed to assess the impact of DAA treatment success on QoL for PWID.

Design: Cross-sectional study using two rounds of the Needle Exchange Surveillance Initiative, a national anonymous bio-behavioural survey, and a longitudinal study involving PWID who underwent DAA therapy.

Setting: Cross-sectional study: Scotland (2017-18, 2019-20). Longitudinal study: Tayside region, Scotland (2019-2021).

Participants: Cross-sectional study: PWID recruited from services providing injecting equipment (n=4009). Longitudinal study: PWID on DAA therapy (n=83).

Measurements: Cross-sectional study: the association between QoL (measured using the EQ-5D-5L quality of life instrument) and HCV diagnosis and treatment was assessed using multilevel linear regression. Longitudinal study: QoL was compared at four timepoints using multilevel regression, from treatment commencement until 12 months following commencement.

Findings: Cross-sectional study: 41% (n=1618) were ever chronically HCV infected, of whom 78% (n=1262) were aware of their status, and of whom 64% (n=704) had undergone DAA therapy. There was no evidence for a marked QoL improvement associated with viral clearance among those treated for HCV (B=0.03, 95% confidence interval [CI]: -0.03 - 0.09). Longitudinal study: improved QoL was observed at the sustained virologic response test timepoint (B=0.18, 95%CI: 0.10-0.27), but this was not maintained at 12 months following start of treatment (B=0.02, 95%CI: -0.05-0.10).

Conclusions: Successful direct-acting antiviral therapy for hepatitis C infection may not lead to a durable improvement in quality of life among people who inject drugs, although there may be a transient improvement around the time of sustained virologic response. Economic models of the impact of scaling-up treatment may need to include more conservative quality of life benefits over and above reductions in mortality, disease progression, and transmission of infection.