{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:39:49Z","timestamp":1760146789617,"version":"build-2065373602"},"reference-count":40,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2024,12,11]],"date-time":"2024-12-11T00:00:00Z","timestamp":1733875200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microorganisms"],"abstract":"<jats:p>People who inject drugs (PWIDs) experience high rates of hepatitis C virus (HCV) infection, primarily due to needle sharing and limited healthcare access, resulting in a disproportionate disease burden within this population. This prospective study evaluated treatment outcomes in 432 adult patients with chronic hepatitis C (CHC) treated with direct-acting antivirals (DAAs) at the University Clinical Center of Serbia. Patients were categorized into two groups based on a history of drug addiction: PWIDs (163, 37.7%) and non-PWIDs (269, 62.3%). The PWID group was further categorized into subpopulations of problematic PWIDs (39, 23.9%), ex-PWIDs (124, 76.1%), and PWIDs on OST (96, 58.9%). The PWID group demonstrated significantly lower treatment adherence, with an intention-to-treat (ITT) rate of 82.8%, compared to 96.3% in the control group (p &lt; 0.001). In contrast, no significant differences were observed in per-protocol (PP) outcomes between the two groups. Additionally, PWIDs were significantly younger (p &lt; 0.001) and had higher rates of psychiatric disorders (p &lt; 0.001), alcohol abuse (p &lt; 0.001), and HCV genotype 1a (p &lt; 0.001). Advanced fibrosis was predictor of PP treatment failure among PWIDs, while mood disorders and alcohol use disorder were associated with interruptions before the scheduled completion time. For non-PWIDs, older age and advanced fibrosis emerged as key predictors of PP treatment failure. The loss to follow-up was most commonly observed in the problematic PWID subgroup (p = 0.001). These findings highlight the importance of addressing barriers in PWIDs through integrated care strategies that concurrently manage addiction and HCV.<\/jats:p>","DOI":"10.3390\/microorganisms12122554","type":"journal-article","created":{"date-parts":[[2024,12,11]],"date-time":"2024-12-11T12:58:49Z","timestamp":1733921929000},"page":"2554","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["HCV Treatment Outcomes in PWID: Impact of Addiction History on SVR12"],"prefix":"10.3390","volume":"12","author":[{"given":"Ivana","family":"Milo\u0161evi\u0107","sequence":"first","affiliation":[{"name":"Clinic for Infectious and Tropical Diseases, University Clinical Center of Serbia, Bulevar Oslobo\u0111enja 16, 11000 Belgrade, Serbia"},{"name":"Faculty of Medicine, University of Belgrade, Dr Subotica 8, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Branko","family":"Beronja","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Belgrade, Dr Subotica 8, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana","family":"Filipovi\u0107","sequence":"additional","affiliation":[{"name":"Clinic for Infectious and Tropical Diseases, University Clinical Center of Serbia, Bulevar Oslobo\u0111enja 16, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nikola","family":"Mitrovi\u0107","sequence":"additional","affiliation":[{"name":"Clinic for Infectious and Tropical Diseases, University Clinical Center of Serbia, Bulevar Oslobo\u0111enja 16, 11000 Belgrade, Serbia"},{"name":"Faculty of Medicine, University of Belgrade, Dr Subotica 8, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jelena","family":"Simi\u0107","sequence":"additional","affiliation":[{"name":"Clinic for Infectious and Tropical Diseases, University Clinical Center of Serbia, Bulevar Oslobo\u0111enja 16, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nata\u0161a","family":"Kne\u017eevi\u0107","sequence":"additional","affiliation":[{"name":"Clinic for Infectious and Tropical Diseases, University Clinical Center of Serbia, Bulevar Oslobo\u0111enja 16, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jovana","family":"Ranin","sequence":"additional","affiliation":[{"name":"Clinic for Infectious and Tropical Diseases, University Clinical Center of Serbia, Bulevar Oslobo\u0111enja 16, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9227-1067","authenticated-orcid":false,"given":"Nevena","family":"Todorovi\u0107","sequence":"additional","affiliation":[{"name":"Clinic for Infectious and Tropical Diseases, University Clinical Center of Serbia, Bulevar Oslobo\u0111enja 16, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olja","family":"Stevanovi\u0107","sequence":"additional","affiliation":[{"name":"Clinic for Infectious and Tropical Diseases, University Clinical Center of Serbia, Bulevar Oslobo\u0111enja 16, 11000 Belgrade, Serbia"},{"name":"Faculty of Medicine, University of Belgrade, Dr Subotica 8, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aleksandra","family":"Radovanovi\u0107-Spurni\u0107","sequence":"additional","affiliation":[{"name":"Clinic for Infectious and Tropical Diseases, University Clinical Center of Serbia, Bulevar Oslobo\u0111enja 16, 11000 Belgrade, Serbia"},{"name":"Faculty of Medicine, University of Belgrade, Dr Subotica 8, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nata\u0161a","family":"Katani\u0107","sequence":"additional","affiliation":[{"name":"Clinic for Infectious and Tropical Diseases, University Clinical Center of Serbia, Bulevar Oslobo\u0111enja 16, 11000 Belgrade, Serbia"},{"name":"Department of Infective Diseases, Faculty of Medicine, University of Pristina Temporarily Settled in Kosovska Mitrovica, 38220 Kosovska Mitrovica, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dejan","family":"Hristovi\u0107","sequence":"additional","affiliation":[{"name":"Clinic for Infectious and Tropical Diseases, Military Academy of the University of Defence, Crnotravska 17, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nata\u0161a","family":"Nikoli\u0107","sequence":"additional","affiliation":[{"name":"Clinic for Infectious and Tropical Diseases, University Clinical Center of Serbia, Bulevar Oslobo\u0111enja 16, 11000 Belgrade, Serbia"},{"name":"Faculty of Medicine, University of Belgrade, Dr Subotica 8, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,12,11]]},"reference":[{"key":"ref_1","unstructured":"Bhattacharya, D., Aronsohn, A., Price, J., Lo Re, V., and AASLD-IDSA HCV Guidance Panel (2023). Hepatitis c Guidance 2023 Update: AASLD-IDSA Recommendations for Testing, Managing, and Treating Hepatitis c Virus Infection. Clin. Infect. Dis., ciad319."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1192","DOI":"10.1016\/S2214-109X(17)30375-3","article-title":"Global Prevalence of Injecting Drug Use and Sociodemographic Characteristics and Prevalence of HIV, HBV, and HCV in People Who Inject Drugs: A Multistage Systematic Review","volume":"5","author":"Degenhardt","year":"2017","journal-title":"Lancet Glob. Health"},{"key":"ref_3","unstructured":"World Health Organization (WHO) (2024, October 31). Global HIV, Hepatitis and STIs Programmes. Available online: https:\/\/www.who.int\/teams\/global-hiv-hepatitis-and-stis-programmes\/populations\/people-who-inject-drugs."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"911","DOI":"10.1016\/j.drugpo.2015.07.004","article-title":"Hepatitis c Virus (HCV) Disease Progression in People Who Inject Drugs (PWID): A Systematic Review and Meta-Analysis","volume":"26","author":"Smith","year":"2015","journal-title":"Int. J. Drug Policy"},{"key":"ref_5","unstructured":"World Health Organization (WHO) (2024, October 31). Hepatitis C. Available online: https:\/\/www.who.int\/teams\/global-hiv-hepatitis-and-stis-programmes\/populations\/people-who-inject-drugs."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1170","DOI":"10.1016\/j.jhep.2020.08.018","article-title":"EASL Recommendations on Treatment of Hepatitis C: Final Update of the Series","volume":"73","author":"Pawlotsky","year":"2020","journal-title":"J. Hepatol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e0241","DOI":"10.1097\/CLD.0000000000000241","article-title":"Hepatitis C virus and integrated care for substance use disorders","volume":"23","author":"Mahoney","year":"2024","journal-title":"Clin Liver Dis."},{"key":"ref_8","unstructured":"World Health Organization (WHO) (2024, October 31). Global Health Sector Strategy on Viral Hepatitis 2016. Available online: https:\/\/www.who.int\/publications\/i\/item\/WHO-HIV-2016.06."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"101626","DOI":"10.1016\/j.clinre.2021.101626","article-title":"HCV virology and diagnosis","volume":"45","author":"Roger","year":"2021","journal-title":"Clin. Res. Hepatol. Gastroenterol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1080\/13814788.2022.2056161","article-title":"Chronic hepatitis C: Diagnosis and treatment made easy","volume":"28","author":"Jacob","year":"2022","journal-title":"Eur. J. Gen. Pract."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"104873","DOI":"10.1016\/j.jcv.2021.104873","article-title":"Diagnosis and monitoring of hepatitis C virus infection using the cobas\u00ae HCV test for use on the cobas\u00ae 4800 system","volume":"141","author":"Ortonne","year":"2021","journal-title":"J. Clin. Virol."},{"key":"ref_12","unstructured":"University of Liverpool (2024, October 31). Hepatitis C Drug Interactions Checker. Hepatitis C Drug Interactions; Liverpool Drug Interactions Group. Available online: https:\/\/www.hep-druginteractions.org\/."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"(2013). World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA, 310, 2191\u20132194.","DOI":"10.1001\/jama.2013.281053"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1016\/S2468-1253(21)00472-6","article-title":"Global change in hepatitis C virus prevalence and cascade of care between 2015 and 2020: A modelling study","volume":"7","author":"Blach","year":"2022","journal-title":"Lancet Gastroenterol. Hepatol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1978","DOI":"10.1016\/j.cgh.2023.04.015","article-title":"The Global Burden of Liver Disease","volume":"21","author":"Younossi","year":"2023","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1159\/000500963","article-title":"Treatment of Chronic Hepatitis C: Efficacy, Side Effects and Complications","volume":"35","author":"Sandmann","year":"2019","journal-title":"Visc. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"4959","DOI":"10.3748\/wjg.v24.i44.4959","article-title":"Hepatitis elimination by 2030: Progress and challenges","volume":"24","author":"Waheed","year":"2018","journal-title":"World J. Gastroenterol."},{"key":"ref_18","unstructured":"Travelers Health (2024, October 31). CDC Yellow Book Hepatitis C, Available online: https:\/\/wwwnc.cdc.gov\/travel\/yellowbook\/2024\/infections-diseases\/hepatitis-c."},{"key":"ref_19","first-page":"100792","article-title":"Prevalence of chronic HCV infection in EU\/EEA countries in 2019 using multiparameter evidence synthesis","volume":"36","author":"Thomadakis","year":"2023","journal-title":"Lancet Reg. Health\u2013Eur."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Han, R., Zhou, J., Fran\u00e7ois, C., and Toumi, M. (2019). Prevalence of hepatitis C infection among the general population and high-risk groups in the EU\/EEA: A systematic review update. BMC Infect. Diseases, 19.","DOI":"10.1186\/s12879-019-4284-9"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"815","DOI":"10.1186\/s13063-022-06724-9","article-title":"M2HepPrEP: Study protocol for a multi-site multi-setting randomized controlled trial of integrated HIV prevention and HCV care for PWID","volume":"23","author":"Feaster","year":"2022","journal-title":"Trials"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"103872","DOI":"10.1016\/j.drugpo.2022.103872","article-title":"Interventions to prevent HIV and Hepatitis C among people who inject drugs: Latest evidence of effectiveness from a systematic review (2011 to 2020)","volume":"109","author":"Palmateer","year":"2022","journal-title":"Int. J. Drug Policy"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Di Marco, L., La Mantia, C., and Di Marco, V. (2022). Hepatitis C: Standard of Treatment and What to Do for Global Elimination. Viruses, 14.","DOI":"10.3390\/v14030505"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e487","DOI":"10.1016\/S2214-109X(19)30462-0","article-title":"Associations between national development indicators and the age profile of people who inject drugs: Results from a global systematic review and meta-analysis","volume":"8","author":"Hines","year":"2020","journal-title":"Lancet Glob. Health"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"S401","DOI":"10.1093\/infdis\/jiaa238","article-title":"Serious Mental Illness Among Young People Who Inject Drugs: An Assessment of Injection Risks and Healthcare Use","volume":"222","author":"Adams","year":"2020","journal-title":"J. Infect. Dis."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1111\/dar.13402","article-title":"Development and assessment of a community-based screening tool for mental health disorders among people who inject drugs","volume":"41","author":"Le","year":"2022","journal-title":"Drug Alcohol Rev."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1055\/s-0040-1716343","article-title":"Alcohol Use Disorder and Hepatitis C Prevention and Care in People Who Inject Drugs: The State of Play","volume":"41","author":"Marcellin","year":"2021","journal-title":"Semin. Liver Dis."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"12","DOI":"10.35946\/arcr.v42.1.12","article-title":"Alcohol\u2019s Negative Emotional Side: The Role of Stress Neurobiology in Alcohol Use Disorder","volume":"42","author":"Sinha","year":"2022","journal-title":"Alcohol Res. Curr. Rev."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1016\/j.jhep.2023.12.020","article-title":"Optimal hepatitis C treatment adherence patterns and sustained virologic response among people who inject drugs: The HERO study","volume":"80","author":"Heo","year":"2024","journal-title":"J. Hepatol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1186\/s13011-020-00287-1","article-title":"Alcohol use disorders and the risk of progression of liver disease in people with hepatitis C virus infection\u2014A systematic review","volume":"15","author":"Shield","year":"2020","journal-title":"Subst. Abus. Treat. Prev. Polic"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1111\/add.14820","article-title":"Untreated alcohol use disorder in people who inject drugs (PWID) in France: A major barrier to HCV treatment uptake (the ANRS-FANTASIO study)","volume":"115","author":"Marcellin","year":"2020","journal-title":"Addiction"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"e2246604","DOI":"10.1001\/jamanetworkopen.2022.46604","article-title":"Association Between Alcohol Use Disorder and Receipt of Direct-Acting Antiviral Hepatitis C Virus Treatment","volume":"5","author":"Haque","year":"2022","journal-title":"JAMA Netw. Open"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1093\/eurpub\/ckad008","article-title":"HIV treatment, antiretroviral adherence and AIDS mortality in people who inject drugs: A scoping review","volume":"33","author":"Feelemyer","year":"2023","journal-title":"Eur. J. Public Health"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"355","DOI":"10.3748\/wjg.v13.i3.355","article-title":"Hepatitis C virus genotypes in Serbia and Montenegro: The prevalence and clinical significance","volume":"13","author":"Svirtlih","year":"2007","journal-title":"World J. Gastroenterol."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Milosevic, I., Todorovic, N., Filipovic, A., Simic, J., Markovic, M., Stevanovic, O., Malinic, J., Katanic, N., Mitrovic, N., and Nikolic, N. (2023). HCV and HCC Tango-Deciphering the Intricate Dance of Disease: A Review Article. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms242216048"},{"key":"ref_36","unstructured":"Pfaeffle, M., Duenkelmann, S., Boesecke, C., Rockstroh, J.K., and Schwarze-Zander, C. (2024). Real-life data of hepatitis C treatment with direct acting antiviral therapy in persons injecting drugs or on opioid substitution therapy. Infection."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Milo\u0161evi\u0107, I., Filipovi\u0107, A., Beronja, B., Mitrovi\u0107, N., Ru\u017ei\u0107, M., Simi\u0107, J., Kne\u017eevi\u0107, N., Pete, M., Todorovi\u0107, N., and Nikoli\u0107, N. (2024). Optimizing Hepatitis C Treatment Monitoring: Is Sustained Virologic Response at 4 Weeks Becoming the New Standard?. Microorganisms, 12.","DOI":"10.3390\/microorganisms12102050"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"625","DOI":"10.7326\/M16-0816","article-title":"C-EDGE CO-STAR Study Group. Elbasvir-grazoprevir to treat hepatitis C virus infection in persons receiving opioid agonist therapy: A randomized trial","volume":"165","author":"Dore","year":"2016","journal-title":"Ann. Intern. Med."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1178221819835847","DOI":"10.1177\/1178221819835847","article-title":"Alcohol and Cannabis Consumption Does Not Diminish Cure Rates in a Real-World Cohort of Chronic Hepatitis C Virus Infected Patients on Opioid Substitution Therapy-Data From the German Hepatitis C-Registry (DHC-R)","volume":"13","author":"Christensen","year":"2019","journal-title":"Subst. Abus. Res. Treat."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"e2335715","DOI":"10.1001\/jamanetworkopen.2023.35715","article-title":"Alcohol Use and Sustained Virologic Response to Hepatitis C Virus Direct-Acting Antiviral Therapy","volume":"6","author":"Cartwright","year":"2023","journal-title":"JAMA Netw. Open"}],"container-title":["Microorganisms"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-2607\/12\/12\/2554\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:52:45Z","timestamp":1760115165000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-2607\/12\/12\/2554"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,11]]},"references-count":40,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["microorganisms12122554"],"URL":"https:\/\/doi.org\/10.3390\/microorganisms12122554","relation":{},"ISSN":["2076-2607"],"issn-type":[{"type":"electronic","value":"2076-2607"}],"subject":[],"published":{"date-parts":[[2024,12,11]]}}}