Håvard Midgard

• Opheim, Eirik; Malme, Kristian Nødtvedt; Dalgard, Olav; Rykkvin, Rikard; Backe, Øystein & Foshaug, Tarjei [Show all 8 contributors for this article] (2026). Prevalence of blood-borne viral infections and HBV vaccination coverage among people with recent injecting drug use in Oslo, 2002–2024. International journal of drug policy. ISSN 0955-3959. 157, p. 105502–105502. doi: 10.1016/j.drugpo.2026.105502. Full text in Research Archive
• Opheim, Eirik; Fredriksen, Anette; Hauge, Joakim; Dalgard, Olav; Malme, Kristian Nødtvedt & Midgard, Håvard (2026). Hepatitis C treatment uptake among incarcerated people in Norway, 2018–2019. Scandinavian Journal of Gastroenterology. ISSN 0036-5521. p. 1–9. doi: 10.1080/00365521.2026.2685826. Full text in Research Archive Show summary

  Introduction: Chronic hepatitis C virus (HCV) infection is common among imprisoned people. We aimed to assess HCV treatment uptake and associated factors before and after imprisonment among incarcerated individuals with chronic HCV infection. Methods: Newly incarcerated individuals in six Norwegian prisons were consecutively included in 2018-2019 and tested for HCV infection. The cohort was linked to national registries for HCV notification status and treatment dispensations. Treatment initiation was defined as dispensation of ≥1 pack (28 days) of HCV treatment. Results: Among 110 individuals with previous or current chronic HCV infection, the median age was 37 years, 79.1% male and 97.2% had ever injected drugs. Chronic HCV infection had been diagnosed in 88 persons before incarceration, of whom 34 (38.6%; 95% CI 28.4-49.6) had already initiated treatment. Among 76 with detectable HCV RNA at inclusion, 62 (81.6%; 95% CI 71.0-89.5) received treatment after incarceration, with a median time to treatment of 5.1 months. Treatment rates increased from 10.6/100 PY (95% CI 7.4-14.9) in the period before incarceration to 79.4/100 PY (95% CI 60.9-101.8) after incarceration. Following incarceration, time to treatment was shorter among individuals with sentence length ≥3 months than among those on remand or with shorter sentences (aHR 1.93; 95% CI 1.10-3.41; p < 0.001). Treatment completion was observed in 57 of 62 (91.9%) participants who initiated treatment after incarceration. Conclusion: HCV treatment uptake following incarceration was high, particularly among those with long sentences. HCV testing in prison should be followed by immediate treatment initiation, regardless of incarceration status and sentence length.

• Hauge, J.; Kielland, Knut Boe; Opheim, Eirik; Jarnæss, Elisabeth; Midgard, Håvard & Dalgard, Olav (2026). Hepatitis C infection among people incarcerated in Norwegian prisons. Scandinavian Journal of Gastroenterology. ISSN 0036-5521. doi: 10.1080/00365521.2026.2624019. Full text in Research Archive
• Pihl, Charlotte Meinich; Malme, Kristian Nødtvedt; Ulstein, K.; Hauge, J.; Backe, Ø. & Foshaug, T. [Show all 8 contributors for this article] (2026). All-cause and liver-related mortality among people who inject drugs with chronic hepatitis C virus infection in Oslo, Norway. Scandinavian Journal of Gastroenterology. ISSN 0036-5521. p. 1–9. doi: 10.1080/00365521.2026.2636072. Full text in Research Archive
• Opheim, Eirik; Malme, Kristian Nødtvedt; Dalgard, Olav; Sørli, Hanne; Backe, Øystein & Foshaug, Tarjei [Show all 16 contributors for this article] (2025). Changes in Risk Behaviour Among People With Recent Injecting Drug Use in Oslo 2002–2024. Drug and Alcohol Review. ISSN 0959-5236. 45(1). doi: 10.1111/dar.70060. Full text in Research Archive
• Razavi, Homie A.; Waked, Imam; Qureshi, Huma; Kondili, Loreta A.; Duberg, Ann-Sofi & Aleman, Soo [Show all 50 contributors for this article] (2025). Number of people treated for hepatitis C virus infection in 2014-2023 and applicable lessons for new HBV and HDV therapies. Journal of Hepatology. ISSN 0168-8278. 83(2), p. 329–347. doi: 10.1016/j.jhep.2025.01.013. Full text in Research Archive Show summary

  Background and aims: The year 2023 marked the 10-year anniversary of the launch of direct-acting antivirals (DAAs) for the treatment of the hepatitis C virus (HCV). HCV treatment trends by country, region, and globally are important to monitor progress toward the World Health Organization's 2030 elimination targets. Additionally, the historical patterns can help predict the treatment uptake for future therapies for other liver diseases. Methods: The number of people living with HCV (PLHCV) treated between 2014-2023 across 119 countries was estimated using national HCV registries, reported DAA sales data, pharmaceutical companies' reports, and estimates provided by national experts. For the countries with no available data, the average estimate of the corresponding Global Burden of Disease region was used. Results: An estimated 13,816,000 (95% uncertainty intervals (UI): 13,221,000-16,415,000) PLHCV were treated, of whom 12,748,000 (12,226,000-15,231,000) were treated with DAAs, of which 11,081,000 (10,542,000-13,338,000) were sofosbuvir-based DAA regimens. Country-level data accounted for 97% of these estimates. In high-income countries, there was a 41% drop in treatment from its peak, and reimbursement was a large predictor of treatment. In low- and middle-income countries, price played an important role in expanding treatment access through the public and private markets, and treatment continues to increase slowly after a sharp drop at the end of the Egyptian national program. Conclusions: In the last 10 years, 21% of all HCV infections were treated with DAAs. Regional and temporal variations highlight the importance of active screening strategies. Without program enhancements, the number of treated PLHCV stalled in every country/region which may not reflect a lower prevalence but may instead reflect the diminishing returns of the existing strategies. Impact and implications: Long-term hepatitis C virus (HCV) infection can lead to cirrhosis and liver cancer. Since 2014, these infections can be effectively treated with 8-12 weeks of oral therapies. In 2015, the World Health Organization (WHO) established targets to eliminate HCV by 2030, which included treatment targets for member countries. The current study examines HCV treatment patterns across 119 countries and regions from 2014 to 2023 to assess the impact of national programs. This study can assist physicians and policymakers in understanding treatment patterns within similar regions or income groups and in utilizing historical data to refine their strategies in the future.

• Whittaker, Robert Neil; Midgard, Håvard; Dalgard, Olav & Kløvstad, Hilde (2024). Treatment uptake among notified cases of hepatitis C virus infection in Norway, 1990 to 2022: a registry-based study to monitor progress towards elimination. Eurosurveillance. ISSN 1025-496X. 29(46). doi: 10.2807/1560-7917.ES.2024.29.46.2400180. Full text in Research Archive Show summary

  Background Hepatitis C virus (HCV) infection is targeted for elimination as a public health threat by 2030. The World Health Organization goal for treatment uptake is ≥ 80% among cases diagnosed with an active HCV infection (RNA- or core antigen-positive), maintained for 2 years. Aim To calculate treatment uptake, time from diagnosis to treatment start and complete treatment dispensation among notified cases of HCV infection in Norway. Method We linked national data on notified cases diagnosed from 1990–2022 to dispensed prescriptions for HCV treatment from January 2004–February 2023 and data on residence status at the end of 2022. We described treatment uptake by demographic and epidemiological characteristics. We calculated the median number of months from diagnosis to treatment start by year. For direct-acting antiviral treatment periods, complete dispensation was based on the treatment and number of defined daily doses. Results Among 12,178 notified cases that had an active infection at diagnosis and were still resident, 10,091 (83%) had received treatment. Uptake among resident cases was > 80% in 2021 and 2022. The median number of months from diagnosis to treatment decreased over time to 3 (interquartile range: 1–5) among cases diagnosed in 2021 and 2022. From 2015–22, 89–93% of direct-acting antiviral treatment periods annually had complete treatment dispensed. Conclusion Norway has achieved the elimination goal for treatment uptake among notified cases diagnosed with an active HCV infection. This highlights the benefit of a strategy that includes unrestricted, simplified and integrated treatment options.

• Druckrey-Fiskaaen, Karl Trygve; Vold, Jørn Henrik; Madebo, Tesfaye; Midgard, Håvard; Dalgard, Olav & Leiva, Rafael Alexander Mo [Show all 7 contributors for this article] (2024). Liver stiffness and associated risk factors among people with a history of injecting drugs: a prospective cohort study. Substance Abuse Treatment, Prevention, and Policy. 19(1). doi: 10.1186/s13011-024-00603-z. Full text in Research Archive Show summary

  Background: Persons with opioid use disorders (OUD) and persons with substance use disorders (SUD) who inject substances have a reduced life expectancy of up to 25 years compared with the general population. Chronic liver diseases are a substantial cause of this. Screening strategies based on liver stiffness measurements (LSM) may facilitate early detection, timely intervention, and treatment of liver disease. This study aims to investigate the extent of chronic liver disease measured with transient elastography and the association between LSM and various risk factors, including substance use patterns, hepatitis C virus (HCV) infection, alcohol use, body mass index, age, type 2 diabetes mellitus, and high-density lipoprotein (HDL) cholesterol among people with OUD or with SUD who inject substances. Methods: Data was collected from May 2017 to March 2022 in a cohort of 676 persons from Western Norway. The cohort was recruited from two populations: Persons receiving opioid agonist therapy (OAT) (81% of the sample) or persons with SUD injecting substances but not receiving OAT. All participants were assessed at least once with transient elastography. A linear mixed model was performed to assess the impact of risk factors such as HCV infection, alcohol use, lifestyle-associated factors, and substance use on liver stiffness at baseline and over time. Baseline was defined as the time of the first liver stiffness measurement. The results are presented as coefficients (in kilopascal (kPa)) with 95% confidence intervals (CI). Results: At baseline, 12% (n = 83) of the study sample had LSM suggestive of advanced chronic liver disease (LSM ≥ 10 kPa). Advanced age (1.0 kPa per 10 years increments, 95% CI: 0.68;1.3), at least weekly alcohol use (1.3, 0.47;2.1), HCV infection (1.2, 0.55;1.9), low HDL cholesterol level (1.4, 0.64;2.2), and higher body mass index (0.25 per increasing unit, 0.17;0.32) were all significantly associated with higher LSM at baseline. Compared with persistent chronic HCV infection, a resolved HCV infection predicted a yearly reduction of LSM (-0.73, -1.3;-0.21) from baseline to the following liver stiffness measurement. Conclusions: More than one-tenth of the participants in this study had LSM suggestive of advanced chronic liver disease. It underscores the need for addressing HCV infection and reducing lifestyle-related liver risk factors, such as metabolic health factors and alcohol consumption, to prevent the advancement of liver fibrosis or cirrhosis in this particular population.

• Malme, Kristian Nødtvedt; Stene-Johansen, Kathrine; Klundby, Ingvild; Backe, Øystein; Foshaug, Tarjei & Greve, Maria Helseth [Show all 10 contributors for this article] (2024). Virologic Response and Reinfection Following HCV Treatment among Hospitalized People Who Inject Drugs: Follow-Up Data from the OPPORTUNI-C Trial. Viruses. 16(6). doi: 10.3390/v16060858. Full text in Research Archive Show summary

  Treatment of hepatitis C among people who inject drugs (PWID) may be complicated by loss to follow-up and reinfection. We aimed to evaluate sustained virologic response (SVR) and reinfection, and to validate complete pharmacy dispensation as a proxy for cure among PWID enrolled in a trial of opportunistic HCV treatment. Data were obtained by reviewing the electronic patient files and supplemented by outreach HCV RNA testing. Reinfection was defined based on clinical, behavioral, and virological data. Intention to treat SVR ≥ 4 within 2 years after enrolment was accomplished by 59 of 98 (60% [95% CI 50–70]) during intervention conditions (opportunistic treatment) and by 57 of 102 (56% [95% CI 46–66]) during control conditions (outpatient treatment). The time to end of treatment response (ETR) or SVR ≥ 4 was shorter among intervention participants (HR 1.55 [1.08–2.22]; p = 0.016). Of participants with complete dispensation, 132 of 145 (91%) achieved ETR or SVR > 4 (OR 12.7 [95% CI 4.3–37.8]; p < 0.001). Four cases of reinfection were identified (incidence 3.8/100 PY [95% CI 1.0–9.7]). Although SVR was similar, the time to virologic cure was shorter among intervention participants. Complete dispensation is a valid correlate for cure among individuals at risk of loss to follow-up. Reinfection following successful treatment remains a concern.

• Razavi-Shearer, Devin M.; Gamkrelidze, Ivane; Pan, Calvin Q.; Jia, Jidong; Berg, Thomas & Gray, Richard T. [Show all 269 contributors for this article] (2023). Global prevalence, cascade of care, and prophylaxis coverage of hepatitis B in 2022: a modelling study. The Lancet Gastroenterology and Hepatology. ISSN 2468-1253. 8(10), p. 879–907. doi: 10.1016/S2468-1253(23)00197-8. Full text in Research Archive
• Midgard, Håvard; Malme, Kristian Braathen; Phil, Charlotte Meinich; Berg-Pedersen, Riikka Mari; Tanum, Lars Håkon Reiestad & Klundby, Ingvild [Show all 12 contributors for this article] (2023). Opportunistic Treatment of Hepatitis C Infection Among Hospitalized People Who Inject Drugs (OPPORTUNI-C): A Stepped Wedge Cluster Randomized Trial. Clinical Infectious Diseases. ISSN 1058-4838. 78(3), p. 582–590. doi: 10.1093/cid/ciad711. Full text in Research Archive Show summary

  Background. We aimed to evaluate the efficacy of opportunistic treatment of hepatitis C virus (HCV) infection among hospitalized people who inject drugs (PWID). Methods. We performed a pragmatic, stepped wedge cluster randomized trial recruiting HCV RNA positive individuals admitted for inpatient care in departments of internal medicine, addiction medicine, and psychiatry at three hospitals in Oslo, Norway. Seven departments were sequentially randomized to change from control conditions (standard of care referral to outpatient care) to intervention conditions (immediate treatment initiation). The primary outcome was treatment completion, defined as dispensing the final package of the prescribed treatment within six months after enrolment. Results. A total of 200 HCV RNA positive individuals were enrolled between 1 October 2019 and 31 December 2021 (mean age 47.4 years, 72.5% male, 60.5% injected past 3 months, 20.4% cirrhosis). Treatment completion was accomplished by 67 of 98 (68.4% [95% confidence interval {CI}: 58.2–77.4]) during intervention conditions and by 36 of 102 (35.3% [95% CI: 26.1–45.4]) during control conditions (risk difference 33.1% [95% CI: 20.0–46.2]; risk ratio 1.9 [95% CI: 1.4–2.6]). The intervention was superior in terms of treatment completion (adjusted odds ratio [aOR] 4.8 [95% CI: 1.8–12.8]; P = .002) and time to treatment initiation (adjusted hazard ratio [aHR] 4.0 [95% CI: 2.5–6.3]; P < .001). Sustained virologic response was documented in 60 of 98 (61.2% [95% CI: 50.8–70.9]) during intervention and in 66 of 102 (64.7% [95% CI: 54.6–73.9]) during control conditions. Conclusions. An opportunistic test-and-treat approach to HCV infection was superior to standard of care among hospitalized PWID. The model of care should be considered for broader implementation. Clinical Trials Registration. NCT04220645 Keywords. hepatitis C virus; people who inject drugs; model of care; pragmatic clinical trial; stepped wedge cluster randomized trial.

• Opheim, Eirik; Dalgard, Olav; Ulstein, Kjersti Anne; Sørlie, Hanne; Backe, Øystein & Foshaug, Tarjei [Show all 8 contributors for this article] (2023). Towards elimination of hepatitis C in Oslo: Cross-sectional prevalence studies among people who inject drugs. International journal of drug policy. ISSN 0955-3959. 123. doi: 10.1016/j.drugpo.2023.104279. Full text in Research Archive
• Malme, Kristian Nødtvedt; Ulstein, Kjersti Anne; Finbråten, Ane-Kristine; Wüsthoff, Linda Elise; Kielland, Knut Boe & Hauge, Joakim [Show all 8 contributors for this article] (2023). Hepatitis C treatment uptake among people who inject drugs in Oslo, Norway: A registry-based study. International journal of drug policy. ISSN 0955-3959. 116. doi: 10.1016/j.drugpo.2023.104044. Full text in Research Archive Show summary

  Background: Improving HCV treatment uptake among people who inject drugs (PWID) is crucial to achieving the WHO elimination targets. The aims were to evaluate HCV treatment uptake and HCV RNA prevalence in a large cohort of PWID in Norway. Methods: Registry-based observational study where all users of the City of Oslo's low-threshold social and health services for PWID between 2010-2016 (n = 5330) were linked to HCV notifications (1990-2019) and dispensions of HCV treatment, opioid agonist treatment (OAT) and benzodiazepines (2004-2019). Cases were weighted to account for spontaneous HCV clearance. Treatment rates were calculated using person-time of observation, and factors associated with treatment uptake were analysed using logistic regression. HCV RNA prevalence was estimated among individuals alive by the end of 2019. Results: Among 2436 participants with chronic HCV infection (mean age 46.8 years, 30.7% female, 73.3% OAT), 1118 (45.9%) had received HCV treatment between 2010-2019 (88.7% DAA-based). Treatment rates increased from 1.4/100 PY (95% CI 1.1-1.8) in the pre-DAA period (2010-2013) to 3.5/100 PY (95% CI 3.0-4.0) in the early DAA period (2014-2016; fibrosis restrictions) and 18.4/100 PY (95% CI 17.2-19.7) in the late DAA period (2017-2019; no restrictions). Treatment rates for 2018 and 2019 exceeded a previously modelled elimination threshold of 50/1000 PWID. Treatment uptake was less likely among women (aOR 0.74; 95% CI 0.62-0.89) and those aged 40-49 years (aOR 0.74; 95% CI 0.56-0.97), and more likely among participants with current OAT (aOR 1.21; 95% CI 1.01-1.45). The estimated HCV RNA prevalence by the end of 2019 was 23.6% (95% CI 22.3-24.9). Conclusion: Although HCV treatment uptake among PWID increased, strategies to improve treatment among women and individuals not engaged in OAT should be addressed.

• Haukeland, John Willy; Midgard, Håvard; Zbigniew, Konopski; Sarna, Vikas Kumar; Grøtta, Ole Jørgen & Kløw, Nils-Einar (2022). Transjugulær intrahepatisk portosystemisk shunt ved portal hypertensjon. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 142(14). doi: 10.4045/tidsskr.21.0911. Full text in Research Archive Show summary

  BAKGRUNN Transjugulær intrahepatisk portosystemisk shunt (TIPS) er en behandling av komplikasjoner ved portal hypertensjon, som gastroøsofageal variceblødning og refraktær ascites. Vi viser her våre erfaringer med denne behandlingsmetoden. MATERIALE OG METODE Alle pasienter som fikk satt inn transjugulær intrahepatisk portosystemisk shunt i perioden 2011–21 ved Oslo universitetssykehus, Ullevål ble studert retrospektivt. Kumulativ insidens av død ble beregnet med levertransplantasjon som konkurrerende hendelse. RESULTATER Prosedyren var teknisk vellykket hos 62 av 64 pasienter. Gjennomsnittlig reduksjon av trykkgradienten mellom vena cava inferior og portvenen var 12,7 mmHg (standardavvik 5,0). 1 av 31 pasienter som fikk utført prosedyren på grunn av gastrointestinal blødning, opplevde en ny blødningsepisode. 4 av 29 pasienter som fikk utført prosedyren på grunn av ascites, hadde behov for ytterligere 1–2 ascitestappinger. 2 av 62 pasienter fikk direkte prosedyrerelaterte komplikasjoner i form av leverabscess og portvenetrombose. 5 av 62 pasienter utviklet symptomer på hjertesvikt eller overvæsking. Etter én, tre og tolv måneder var henholdsvis 49 av 62 (79 %), 45 av 62 (73 %) og 38 av 62 (61 %) fortsatt i live. Prosedyren fungerte som «bro til levertransplantasjon» for åtte pasienter med refraktær ascites. FORTOLKNING Transjugulær intrahepatisk portosystemisk shunt er en nyttig behandlingsmetode for komplikasjoner ved portal hypertensjon.

• Midgard, Håvard; Bjørnestad, Ronny; Egeland, Maren; Dahl, Eivin; Finbråten, Ane-Kristine & Kielland, Knut Boe [Show all 8 contributors for this article] (2022). Peer support in small towns: A decentralized mobile Hepatitis C virus clinic for people who inject drugs. Liver international (Print). ISSN 1478-3223. 42(6), p. 1268–1277. doi: 10.1111/liv.15266. Full text in Research Archive Show summary

  Background & aims: New models of HCV care are needed to reach people who inject drugs (PWID). The primary aim was to evaluate HCV treatment uptake among HCV RNA positive individuals identified by point-of-care (POC) testing and liver disease assessment in a peer-driven decentralized mobile clinic. Methods: This prospective study included consecutive patients assessed in a mobile clinic visiting 32 small towns in Southern Norway from November 2019 to November 2020. The clinic was staffed by a bus driver and a social educator offering POC HCV RNA testing (GeneXpert®), liver disease staging (FibroScan® 402) and peer support. Viremic individuals were offered prompt pan-genotypic treatment prescribed by local hospital-employed specialists following a brief telephone assessment. Results: Among 296 tested individuals, 102 (34%) were HCV RNA positive (median age 51 years, 77% male, 24% advanced liver fibrosis/cirrhosis). All participants had a history of injecting drug use, 71% reported past 3 months injecting, and 37% received opioid agonist treatment. Treatment uptake within 6 months following enrolment was achieved in 88%. Treatment uptake was negatively associated with recent injecting (aHR 0.60; 95% CI 0.36-0.98), harmful alcohol consumption (aHR 0.44; 95% CI 0.20-0.99), and advanced liver fibrosis/cirrhosis (aHR 0.44; 95% CI 0.25-0.80). HCV RNA prevalence increased with age (OR 1.81 per 10-year increase; 95% 1.41-2.32), ranging from 3% among those <30 years to 55% among those ≥60 years. Conclusions: A peer-driven mobile HCV clinic is an effective and feasible model of care that should be considered for broader implementation to reach PWID outside the urban centres. Keywords: hepatitis C virus; peer support; people who inject drugs; point of care; treatment. © 2022 The Authors. Liver International published by John Wiley & Sons Ltd.

• Busschots, Dana; Bielen, Rob; Koc, Özgür M.; Heyens, Leen; Verrando, Rita & Galocsy, Chantal de [Show all 11 contributors for this article] (2021). Hepatitis C reinfection in former and active injecting drug users in Belgium. Harm Reduction Journal. 18(1), p. 1–7. doi: 10.1186/s12954-021-00552-x. Full text in Research Archive
• Fadnes, Lars T.; Aas, Christer Frode; Vold, Jørn Henrik; Leiva, Rafael Alexander Mo; Ohldieck, Christian & Chalabianloo, Fatemeh [Show all 13 contributors for this article] (2021). Integrated treatment of hepatitis C virus infection among people who inject drugs: A multicenter randomized controlled trial (INTRO-HCV). PLoS Medicine. ISSN 1549-1277. 18(6). doi: 10.1371/journal.pmed.1003653. Full text in Research Archive Show summary

  Background The standard pathways of testing and treatment for hepatitis C virus (HCV) infection in tertiary healthcare are not easily accessed by people who inject drugs (PWID). The aim of this study was to evaluate the efficacy of integrated treatment of chronic HCV infection among PWID. Methods and findings INTRO-HCV is a multicenter, randomized controlled clinical trial. Participants recruited from opioid agonist therapy (OAT) and community care clinics in Norway over 2017 to 2019 were randomly 1:1 assigned to the 2 treatment approaches. Integrated treatment was delivered by multidisciplinary teams at opioid agonist treatment clinics or community care centers (CCCs) for people with substance use disorders. This included on-site testing for HCV, liver fibrosis assessment, counseling, treatment, and posttreatment follow-up. Standard treatment was delivered in hospital outpatient clinics. Oral direct-acting antiviral (DAA) medications were administered in both arms. The study was not completely blinded. The primary outcomes were time-to-treatment initiation and sustained virologic response (SVR), defined as undetectable HCV RNA 12 weeks after treatment completion, analyzed with intention to treat, and presented as hazard ratio (HR) and odds ratio (OR) with 95% confidence intervals. Among 298 included participants, 150 were randomized to standard treatment, of which 116/150 (77%) initiated treatment, with 108/150 (72%) initiating within 1 year of referral. Among those 148 randomized to integrated care, 145/148 (98%) initiated treatment, with 141/148 (95%) initiating within 1 year of referral. The HR for the time to initiating treatment in the integrated arm was 2.2 (1.7 to 2.9) compared to standard treatment. SVR was confirmed in 123 (85% of initiated/83% of all) for integrated treatment compared to 96 (83% of initiated/64% of all) for the standard treatment (OR among treated: 1.5 [0.8 to 2.9], among all: 2.8 [1.6 to 4.8]). No severe adverse events were linked to the treatment. Conclusions Integrated treatment for HCV in PWID was superior to standard treatment in terms of time-to-treatment initiation, and subsequently, more people achieved SVR. Among those who initiated treatment, the SVR rates were comparable. Scaling up of integrated treatment models could be an important tool for elimination of HCV.

• Midgard, Håvard; Ulstein, Kjersti Anne; Backe, Øystein; Foshaug, Tarjei; Sørli, Hanne & Vennesland, Kristin [Show all 11 contributors for this article] (2021). Hepatitis C treatment and reinfection surveillance among people who inject drugs in a low-threshold program in Oslo, Norway. International journal of drug policy. ISSN 0955-3959. 96. doi: 10.1016/j.drugpo.2021.103165. Full text in Research Archive
• Haukeland, John Willy; Småstuen, Milada Cvancarova; Pålsdatter, Pia Pernille; Ismail, Moonisah; Zbigniew, Konopski & Jørgensen, Kristin Kaasen [Show all 8 contributors for this article] (2020). Effect of gender on mortality and causes of death in cirrhotic patients with gastroesophageal varices. A retrospective study in Norway. PLOS ONE. 15(3), p. 1–16. doi: 10.1371/journal.pone.0230263. Full text in Research Archive Show summary

  Background & aims The prognostic role of gender in patients with liver cirrhosis is not fully understood. Our primary aim was to assess how gender affects cumulative incidence and risk of death without liver transplantation (LT) in cirrhotic patients with gastroesophageal varices. Secondary aims were to assess the relationship between gender and cause specific death, risk of variceal bleeding and incidence rates of gastroesophageal varices in patients with cirrhosis. Methods All new patients with gastroesophageal varices due to liver cirrhosis at Oslo University Hospital between 2006 and May 2016 were identified. Clinical data were retrieved retrospectively from hospital files. Causes of death were classified according to a specified protocol in cases of in-hospital-death, otherwise by data from the Norwegian Death Registry. Competing risk analyses were used to calculate cumulative incidences and risks of i) all-cause death, ii) cause-specific death and iii) variceal bleeding or re-bleeding. Results Cumulative one- and five years incidence of death without LT in 266 included patients were 28% and 51%, respectively. In univariate analysis, risk of death was positively associated with age, Child Pugh class, alcoholic liver disease and presentation with variceal bleeding, and negatively associated with female sex. In a multivariate model, risk of death without LT was associated with female sex (SHR 0.59 [0.40–0.86]), age (SHR 1.05 [1.04–1.07] per year), Child Pugh class B (SHR 1.54 [1.03–2.32]) and Child Pugh class C (SHR 4.29 [2.57–7.17]). Variceal bleeding caused 27% of deaths. Adjusting for age and Child Pugh score, a trend towards reduced risk of death due to variceal bleeding was seen in women (SHR 0.53; [0.26–1.06]). High alcohol consumption was associated with increased risk of first variceal bleeding, both at univariate analysis (SHR 7.73 [1.71–34.9]) and multivariate analysis (SHR 13.9 [2.51–77.0]). Conclusions Reduced mortality due to variceal bleeding may contribute to improved survival without LT in cirrhotic women with gastroesophageal varices.

• Midgard, Håvard; Finbråten, Ane-Kristine; Malme, Kristian Nødtvedt; Berg-Pedersen, Riikka Mari; Tanum, Lars Håkon Reiestad & Christoffer, Olsen Inge [Show all 8 contributors for this article] (2020). Opportunistic treatment of hepatitis C virus infection (OPPORTUNI-C): study protocol for a pragmatic stepped wedge cluster randomized trial of immediate versus outpatient treatment initiation among hospitalized people who inject drugs. Trials. 21(1), p. 524–524. doi: 10.1186/s13063-020-04434-8. Full text in Research Archive Show summary

  Background: Scaled-up direct-acting antiviral (DAA) treatment of hepatitis C virus (HCV) infection among people who inject drugs (PWID) is crucial to reach the World Health Organization HCV elimination targets within 2030. One of the critical obstacles to HCV care in this population is the lack of treatment models within specialist healthcare adapted to marginalized individuals. Methods: OPPORTUNI-C is a pragmatic stepped wedge cluster randomized trial comparing the efficacy of immediate initiation of HCV treatment with the current standard of care among PWID admitted for inpatient care. Screening for HCV RNA will be performed as soon as possible after admission. The intervention includes immediate non-invasive liver disease assessment, counseling, and initiation of pan-genotypic DAA treatment with individualized follow-up. Standard of care is a referral to outpatient care at discharge. To mimic usual clinical practice as closely as possible, we will use a pragmatic clinical trial approach utilizing clinical infrastructure, broad eligibility criteria, flexible intervention delivery, clinically relevant outcomes, and collection of data readily available from the electronic patient files. The stepped wedge design involves a sequential rollout of the intervention over 16 months, in which seven participating clusters will be randomized from standard of care to intervention in a stepwise manner. Randomization will be stratified according to cluster size to keep high prevalence clusters separated. The trial will include approximately 220 HCV RNA positive individuals recruited from departments of internal medicine, addiction medicine, and psychiatry at Akershus University Hospital, Oslo University Hospital, and Lovisenberg Diaconal Hospital, Oslo, Norway. Individuals not able or willing to give informed consent and those with ongoing HCV assessment or treatment will be excluded. The primary outcome is treatment completion, defined as dispensing of the final prescribed DAA package from the pharmacy within 6 months after inclusion. Secondary outcomes include treatment uptake, virologic response, reinfection incidence, and resistance-associated substitutions. Discussion: Representing a novel model of care suited to reach and engage marginalized PWID in HCV care, this study will inform HCV elimination efforts locally and internationally. If the model proves efficacious and feasible, it should be considered for broader implementation, replacing the current standard of care.

• Hajarizadeh, Behzad; Cunningham, Evan B.; Valerio, Heather; Martinello, Marianne; Law, Matthew & Janjua, Naveed Z. [Show all 13 contributors for this article] (2020). Hepatitis C reinfection after successful antiviral treatment among people who inject drugs: A meta-analysis. Journal of Hepatology. ISSN 0168-8278. 72(4), p. 643–657. doi: 10.1016/j.jhep.2019.11.012. Full text in Research Archive
• Safreed-Harmon, Kelly; Blach, Sarah; Aleman, Soo; Bollerup, Signe; Cooke, Graham & Dalgard, Olav [Show all 17 contributors for this article] (2019). The Consensus Hepatitis C Cascade of Care: standardized reporting to monitor progress toward elimination. Clinical Infectious Diseases. ISSN 1058-4838. 69(12), p. 2218–2227. doi: 10.1093/cid/ciz714. Full text in Research Archive Show summary

  Abstract Cascade-of-care (CoC) monitoring is an important component of the response to the global hepatitis C virus (HCV) epidemic. CoC metrics can be used to communicate in simple terms the extent to which national and subnational governments are advancing on key targets, and CoC findings can inform strategic decision-making regarding how to maximize the progression of HCV-infected individuals to diagnosis, treatment and cure. The value of reporting would be enhanced if reporting entities utilized a standardized approach for generating their CoCs. We have described the Consensus HCV CoC that we developed to address this need and have presented findings from Denmark, Norway and Sweden, where it was piloted. We encourage the uptake of the Consensus HCV CoC as a global instrument for facilitating clear and consistent reporting via the World Health Organization (WHO) viral hepatitis monitoring platform and ensuring the accurate monitoring of progress toward WHO's 2030 hepatitis C elimination targets.

• Gulati, Rachna Shridhar; Wimalanathan, Thakshani; Andersen, Solveig Norheim; Isaksen, Kjetil; Lagging, Martin & Midgard, Håvard [Show all 8 contributors for this article] (2019). The relationship between IFNL4 genotype and the rate of fibrosis in hepatitis C patients. Scandinavian Journal of Gastroenterology. ISSN 0036-5521. 54(9), p. 1172–1175. doi: 10.1080/00365521.2019.1643403. Full text in Research Archive
• Fadnes, Lars T.; Aas, Christer Frode; Vold, Jørn Henrik; Ohldieck, Christian; Leiva, Rafael Alexander Mo & Chalabianloo, Fatemeh [Show all 13 contributors for this article] (2019). Integrated treatment of hepatitis C virus infection among people who inject drugs: study protocol for a randomised controlled trial (INTRO-HCV). BMC Infectious Diseases. 19:943, p. 1–9. doi: 10.1186/s12879-019-4598-7. Full text in Research Archive Show summary

  Background: A large proportion of people who inject drugs (PWID) living with hepatitis C virus (HCV) infection have not been treated. It is unknown whether inclusion of HCV diagnostics and treatment into integrated substance use disorder treatment and care clinics will improve uptake and outcome of HCV treatment in PWID. The aim is to assess the efficacy of integrating HCV treatment to PWID and this paper will present the protocol for an ongoing trial. Methods: INTRO-HCV is a multicentre, randomised controlled clinical trial that will compare the efficacy of integrated treatment of HCV in PWID with the current standard treatment. Integrated treatment includes testing for HCV, assessing liver fibrosis with transient elastography, counselling, treatment delivery, follow-up and evaluation provided by integrated substance use disorder treatment and care clinics. Most of these clinics for PWID provide opioid agonist therapy while some clinics provide low-threshold care without opioid agonist therapy. Standard care involves referral to further diagnostics, treatment and treatment follow-up given in a hospital outpatient clinic with equivalent medications. The differences between the delivery platforms in the two trial arms involve use of a drop-in approach rather than specific appointment times, no need for additional travelling, less blood samples taken during treatment, and treatment given from already known clinicians. The trial will recruit approximately 200 HCV infected individuals in Bergen and Stavanger, Norway. The primary outcomes are time to treatment initiation and sustained virologic response, defined as undetectable HCV RNA 12 weeks after end of treatment. Secondary outcomes are cost-effectiveness, treatment adherence, changes in quality of life, fatigue and psychological well-being, changes in drug use, infection related risk behaviour, and risk of reinfection. The target group is PWID with HCV diagnosed receiving treatment and care within clinics for PWID. Discussion: This study will inform on the effects of an integrated treatment program for HCV in clinics for PWID compared to standard care aiming to increase access to treatment and improving treatment adherence. If the integrated treatment model is found to be safe and efficacious, it can be considered for further scale-up.

• Fraser, Hannah; Martin, Natasha K.; Brummer-Korvenkontio, Henrikki; Carrieri, Patrizia; Dalgard, Olav & Dillon, John [Show all 23 contributors for this article] (2018). Model projections on the impact of HCV treatment in the prevention of HCV transmission among people who inject drugs in Europe. Journal of Hepatology. ISSN 0168-8278. 68(3), p. 402–411. doi: 10.1016/j.jhep.2017.10.010. Full text in Research Archive Show summary

  Background & Aims Prevention of hepatitis C virus (HCV) transmission among people who inject drugs (PWID) is critical for eliminating HCV in Europe. We estimated the impact of current and scaled-up HCV treatment with and without scaling up opioid substitution therapy (OST) and needle and syringe programmes (NSPs) across Europe over the next 10 years. Methods We collected data on PWID HCV treatment rates, PWID prevalence, HCV prevalence, OST, and NSP coverage from 11 European settings. We parameterised an HCV transmission model to setting-specific data that project chronic HCV prevalence and incidence among PWID. Results At baseline, chronic HCV prevalence varied from <25% (Slovenia/Czech Republic) to >55% (Finland/Sweden), and <2% (Amsterdam/Hamburg/Norway/Denmark/Sweden) to 5% (Slovenia/Czech Republic) of chronically infected PWID were treated annually. The current treatment rates using new direct-acting antivirals (DAAs) may achieve observable reductions in chronic prevalence (38–63%) in 10 years in Czech Republic, Slovenia, and Amsterdam. Doubling the HCV treatment rates will reduce prevalence in other sites (12–24%; Belgium/Denmark/Hamburg/Norway/Scotland), but is unlikely to reduce prevalence in Sweden and Finland. Scaling-up OST and NSP to 80% coverage with current treatment rates using DAAs could achieve observable reductions in HCV prevalence (18–79%) in all sites. Using DAAs, Slovenia and Amsterdam are projected to reduce incidence to 2 per 100 person years or less in 10 years. Moderate to substantial increases in the current treatment rates are required to achieve the same impact elsewhere, from 1.4 to 3 times (Czech Republic and France), 5–17 times (France, Scotland, Hamburg, Norway, Denmark, Belgium, and Sweden), to 200 times (Finland). Scaling-up OST and NSP coverage to 80% in all sites reduces treatment scale-up needed by 20–80%. Conclusions The scale-up of HCV treatment and other interventions is needed in most settings to minimise HCV transmission among PWID in Europe.

• Bjøro, Benedikte; Dalgard, Olav; Midgard, Håvard; Verbaan, Hans; Småstuen, Milada Cvancarova & Rustøen, Tone (2018). Increased hope following successful treatment for hepatitis C infection. Journal of Advanced Nursing. ISSN 0309-2402. 74(3), p. 724–733. doi: 10.1111/jan.13487. Full text in Research Archive
• Day, Emma; Hellard, Margaret; Treloar, Carla; Bruneau, Julie; Martin, Natasha K. & Øvrehus, Anne [Show all 19 contributors for this article] (2018). Hepatitis C elimination among people who inject drugs: Challenges and recommendations for action within a health systems framework. Liver international (Print). ISSN 1478-3223. p. 1–11. doi: 10.1111/liv.13949. Full text in Research Archive
• Cunningham, Evan B.; Hajarizadeh, Behzad; Dalgard, Olav; Amin, Janaki; Hellard, Margaret & Foster, Graham R. [Show all 48 contributors for this article] (2017). Adherence to response-guided pegylated interferon and ribavirin for people who inject drugs with hepatitis C virus genotype 2/3 infection: The ACTIVATE study. BMC Infectious Diseases. 17(1). doi: 10.1186/s12879-017-2517-3. Full text in Research Archive Show summary

  Background The aims of this analysis were to investigate treatment completion and adherence among people with ongoing injecting drug use or receiving opioid substitution therapy (OST) in a study of response-guided therapy for chronic HCV genotypes 2/3 infection. Methods ACTIVATE was a multicenter clinical trial recruited between 2012 and 2014. Participants with genotypes 2/3 were treated with directly observed peg-interferon alfa-2b (PEG-IFN) and self-administered ribavirin for 12 (undetectable HCV RNA at week 4) or 24 weeks (detectable HCV RNA at week 4). Outcomes included treatment completion, PEG-IFN adherence, ribavirin adherence, and sustained virological response (SVR, undetectable HCV RNA >12 weeks post-treatment). Results Among 93 people treated, 59% had recently injected drugs (past month), 77% were receiving OST and 56% injected drugs during therapy. Overall, 76% completed treatment. Mean on-treatment adherence to PEG-IFN and ribavirin were 98.2% and 94.6%. Overall, 6% of participants missed >1 dose of PEG-IFN and 31% took <95% of their prescribed ribavirin., Higher treatment completion was observed among those receiving 12 vs. 24 weeks of treatment (97% vs. 46%, P < 0.001) while the proportion of participants with 95% on-treatment ribavirin adherence was similar between groups (67% vs. 72%, P = 0.664). Receiving 12 weeks of therapy was independently associated with treatment completion. No factors were associated with 95% RBV adherence. Neither recent injecting drug use at baseline nor during therapy was associated with treatment completion or adherence to ribavirin. In adjusted analysis, treatment completion was associated with SVR (aOR 23.9, 95% CI 2.9–193.8). Conclusions This study demonstrated a high adherence to directly observed PEG-IFN and self-administered ribavirin among people with ongoing injecting drug use or receiving OST. These data also suggest that shortening therapy from 24 to 12 weeks can lead to improved treatment completion. Treatment completion was associated with improved response to therapy.

• Grebely, Jason; Bruneau, Julie; lazarus, jeffrey; Dalgard, Olav; Bruggmann, Philip & Treloar, Carla [Show all 28 contributors for this article] (2017). Research priorities to achieve universal access to hepatitis C prevention, management and direct-acting antiviral treatment among people who inject drugs. International journal of drug policy. ISSN 0955-3959. 47, p. 51–60. doi: 10.1016/j.drugpo.2017.05.019. Full text in Research Archive Show summary

  Globally, it is estimated that 71.1 million people have chronic hepatitis C virus (HCV) infection, including an estimated 7.5 million people who have recently injected drugs (PWID). There is an additional large, but unquantified, burden among those PWID who have ceased injecting. The incidence of HCV infection among current PWID also remains high in many settings. Morbidity and mortality due to liver disease among PWID with HCV infection continues to increase, despite the advent of well-tolerated, simple interferon-free direct-acting antiviral (DAA) HCV regimens with cure rates >95%. As a result of this important clinical breakthrough, there is potential to reverse the rising burden of advanced liver disease with increased treatment and strive for HCV elimination among PWID. Unfortunately, there are many gaps in knowledge that represent barriers to effective prevention and management of HCV among PWID. The Kirby Institute, UNSW Sydney and the International Network on Hepatitis in Substance Users (INHSU) established an expert round table panel to assess current research gaps and establish future research priorities for the prevention and management of HCV among PWID. This round table consisted of a one-day workshop held on 6 September, 2016, in Oslo, Norway, prior to the International Symposium on Hepatitis in Substance Users (INHSU 2016). International experts in drug and alcohol, infectious diseases, and hepatology were brought together to discuss the available scientific evidence, gaps in research, and develop research priorities. Topics for discussion included the epidemiology of injecting drug use, HCV, and HIV among PWID, HCV prevention, HCV testing, linkage to HCV care and treatment, DAA treatment for HCV infection, and reinfection following successful treatment. This paper highlights the outcomes of the roundtable discussion focused on future research priorities for enhancing HCV prevention, testing, linkage to care and DAA treatment for PWID as we strive for global elimination of HCV infection.

• Grebely, Jason; Dalgard, Olav; Cunningham, Evan B.; Hajarizadeh, Behzad; Foster, Graham R. & Bruggmann, Philip [Show all 23 contributors for this article] (2017). Efficacy of response-guided directly observed pegylated interferon and self-administered ribavirin for people who inject drugs with hepatitis C virus genotype 2/3 infection: The ACTIVATE study. International journal of drug policy. ISSN 0955-3959. 47, p. 177–186. doi: 10.1016/j.drugpo.2017.05.020. Full text in Research Archive Show summary

  Background There are few data on treatment for hepatitis C virus (HCV) infection among people with ongoing injecting drug use. This study evaluated the efficacy of response-guided therapy for chronic HCV genotypes 2/3 infection among people with ongoing injecting drug use or receiving opioid substitution therapy (OST). A secondary aim was to identify predictors of HCV treatment response. Methods ACTIVATE was a multicentre clinical trial recruited between 2012 and 2014. Participants with genotypes 2/3 were treated with directly observed peg-interferon alfa-2b and self-administered ribavirin for 12 (undetectable HCV RNA at week 4) or 24 weeks (detectable HCV RNA at week 4). Participants were recruited from drug treatment clinics, private practices, hospital clinics and community clinics in Australia, Canada, and five countries in Europe. The primary study outcome was sustained virological response (SVR, undetectable HCV RNA >12 weeks post-treatment). Results Among 93 people with ongoing injecting drug use or receiving OST treated for HCV genotype 2/3, 59% had recently (past month) injected drugs, 77% were receiving OST and 56% injected drugs during therapy. Overall SVR was 66% (61/93). SVR was 84% in those with undetectable HCV RNA at week 4 (12 weeks) compared to 38% in those without (24 weeks). In adjusted analysis, cirrhosis vs. no/mild fibrosis [adjusted OR (aOR) 0.33, 95% CI 0.13, 0.86] predicted reduced SVR, while response at week 4 was associated with increased SVR [aOR 8.11, 95% CI 2.73, 24.10]. Recent injecting drug use at baseline or during therapy was not associated with SVR. Conclusion This study demonstrates that people with recent injecting drug use or OST with chronic HCV can achieve responses to interferon-based therapy similar to other populations, despite injecting drugs prior to or during therapy. Cirrhosis was predictive of reduced response to HCV therapy, while response at week 4 (despite shortened therapy) was predictive of improved response.

• Midgard, Håvard; Hajarizadeh, Behzad; Cunningham, Evan B.; Conway, Brian; Backmund, Markus & Bruggmann, Philip [Show all 20 contributors for this article] (2017). Changes in risk behaviours during and following treatment for hepatitis C virus infection among people who inject drugs: The ACTIVATE study. International journal of drug policy. ISSN 0955-3959. 47, p. 230–238. doi: 10.1016/j.drugpo.2017.05.040. Full text in Research Archive
• Midgard, Håvard; Bjøro, Benedikte; Mæland, Arild; Zbigniew, Konopski; Kileng, Hege & Damås, Jan Kristian [Show all 15 contributors for this article] (2016). Hepatitis C reinfection after sustained virological response. Journal of Hepatology. ISSN 0168-8278. 64(5), p. 1020–1026. doi: 10.1016/j.jhep.2016.01.001. Full text in Research Archive
• Midgard, Håvard; Weir, Amanda; Palmateer, Nora; 3rd, Vincent Lo Ve; Pineda, Juan A. & Macias, Juan [Show all 7 contributors for this article] (2016). HCV epidemiology in high-risk groups and the risk of reinfection. Journal of Hepatology. ISSN 0168-8278. 1 Suppl , p. 33–45. doi: 10.1016/j.jhep.2016.07.012. Full text in Research Archive
• Midgard, Håvard; Bramness, Jørgen Gustav; Skurtveit, Svetlana; Haukeland, John Willy & Dalgard, Olav (2016). Hepatitis C Treatment Uptake among Patients Who Have Received Opioid Substitution Treatment: A Population-Based Study. PLOS ONE. 11(11). doi: 10.1371/journal.pone.0166451. Full text in Research Archive Show summary

  Background and Aims There is limited data on hepatitis C (HCV) treatment uptake among people who inject drugs including individuals receiving opioid substitution treatment (OST). We aimed to calculate cumulative HCV treatment uptake, estimate annual treatment rates, and identify factors associated with HCV treatment among individuals who have received OST in Norway. Methods This observational study was based on linked data from The Norwegian Prescription Database and The Norwegian Surveillance System for Communicable Diseases between 2004 and 2013. Both registries have national coverage. From a total of 9919 individuals who had been dispensed OST (methadone, buprenorphine or buprenorphine-naloxone), we included 3755 individuals who had been notified with HCV infection. In this population, dispensions of HCV treatment (pegylated interferon and ribavirin), benzodiazepines, selective serotonin reuptake inhibitors and antipsychotics were studied. Results Among 3755 OST patients notified with HCV infection, 539 (14%) had received HCV treatment during the study period. Annual HCV treatment rates during OST ranged between 1.3% (95% confidence interval [CI] 0.7-2.2) in 2005 and 2.6% (95% CI 1.9-3.5) in 2008 with no significant changes over time. HCV treatment uptake was not associated with age or gender, but associated with duration of active OST (adjusted odds ratio [aOR] 1.11 per year; 95% CI 1.07-1.15), high (> 80%) OST continuity (aOR 1.62; 95% CI 1.17-2.25), and heavy benzodiazepine use (aOR 0.65; 95% CI 0.49-0.87). Conclusions Cumulative HCV treatment uptake among OST patients notified with HCV infection in Norway between 2004 and 2013 was 14%. Annual treatment rates during OST remained unchanged below 3% per year. High continuity of OST over time and absence of heavy benzodiazepine use predicted HCV treatment uptake. Increased awareness for HCV among OST patients is needed as tolerable and efficient directly acting antiviral treatment is being introduced.

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• Midgard, Håvard; Malme, Kristian Nødtvedt; Finbråten, Ane-Kristine & Dalgard, Olav (2025). Treatment Completion and Sustained Virologic Response in the Context of Hepatitis C Virus Elimination: Time to Let Go of the Reins? Clinical Infectious Diseases. ISSN 1058-4838. 80(3), p. 684–685. doi: 10.1093/cid/ciae298. Full text in Research Archive
• Johannessen, Asgeir & Midgard, Håvard (2024). Hepatitt-test til alle. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 144(9). doi: 10.4045/tidsskr.24.0365. Full text in Research Archive
• Hauge, Joakim; Kielland, Knut Boe; Jarnaess, E.; Midgard, Håvard & Dalgard, Olav (2021). The HEPRIS Study -Prevalence of Hepatitis C in Norwegian Prisons. Full text in Research Archive
• Midgard, Håvard; Kielland, Knut Boe & Dalgard, Olav (2018). Eliminasjon av hepatitt C er mulig. 138(7), p. 630–633. doi: 10.4045/tidsskr.18.0099. Full text in Research Archive
• Razavi-Shearer, D; Dalgard, Olav; Midgard, Håvard; Razavi, H; Wüsthoff, Linda Elise & Kielland, Knut Boe (2016). Aggressive treatment of hepatitis C in People who inject drugs in Norway: an integral step to eradicate the infection in this population. Full text in Research Archive
• Kran, Anne-Marte Bakken; Håvelsrud, Othilde Elise; Storm, Margrethe Larsdatter; Blix, Hege Salvesen; Bragstad, Karoline & Rohringer, Andreas [Show all 18 contributors for this article] (2025). Usage of Antivirals and the Occurrence of Antiviral Resistance in Norway 2024. RAVN. Folkehelseinstituttet. ISSN 9788284065236. Full text in Research Archive Show summary

  Den årlige rapporten for Resistensovervåking av virus i Norge (RAVN) presenterer norske data om antiviral resistens og belyser temaer knyttet til behandling av virusinfeksjoner.

• Whittaker, Robert; Kløvstad, Hilde; Blindheim, Martin Ingvald; Skullerud, Kristin Helene; Dalgard, Olav & Midgard, Håvard [Show all 9 contributors for this article] (2023). Statusrapport om eliminasjon av hepatitt B og C som folkehelseproblem i Norge. Folkehelseinstituttet. Full text in Research Archive Show summary

  Helse- og omsorgsdepartementet lanserte en nasjonal strategi mot virale hepatitter i 2016, som ble videreutviklet i 2018. Hepatitt B virus- (HBV) og hepatitt C virus- (HCV) infeksjon er globalt ledende årsaker til leverkreft og leversvikt. I Norge anses prevalensen av kronisk HBV- og HCV-infeksjon for å være lav i den generelle befolkningen, men forekomsten har vært høy i risikoutsatte grupper, særlig blant personer som har injisert rusmidler og innvandrere fra land med høy prevalens av hepatitt B eller C. I tråd med FNs globale bærekraftsmål og WHO sin globale helsestrategi har Norge som mål å eliminere hepatitt B og C som folkehelseproblem. Med ‘eliminasjon’ menes reduksjon av smitte og sykdom til et så lavt nivå at det ikke lenger utgjør et problem for folkehelsen. Eliminasjon defineres for flere områder, inkludert insidens av nye tilfeller, insidens av alvorlig sykdom og dødsfall og dekningsmål i helsetjenesten. Dekningsmål omfatter oppfølgning i helsetjenesten, behandlingsopptak, vaksinasjonsdekning, trygge blodprodukter og injeksjoner, og skadereduserende tiltak. Formålet med denne rapporten er å: • Presentere oppdatert kunnskap om forekomst av hepatitt B og C i Norge. • Vurdere status for de igangsatte tiltakene i hepatittstrategiene opp mot nasjonale og internasjonale mål. • Gi råd for videreføring av arbeidet mot eliminasjon av hepatitt B og C som folkehelseproblem i Norge.

• Kran, Anne-Marte Bakken; Storm, Margrethe Larsdatter; Håvelsrud, Othilde Elise; Litleskare, Irene; Bragstad, Karoline & Stene-Johansen, Kathrine [Show all 14 contributors for this article] (2022). Usage of Antivirals and the Occurrence of Antiviral Resistance in Norway 2021. RAVN. Norwegian Institute of Public Health, Division of Infection Control. ISSN 9788284063225. Full text in Research Archive Show summary

  The usage of antivirals According to The Norwegian Drug Wholesales Statistics Database, the sales of antiviral drugs measured in defined daily doses (DDDs) were reduced in 2021, after several years of increase. This reduction was primarily due to a small decrease in sales of antivirals against HIV, which make up a large proportion of the antiviral drugs sold in Norway. There was no decrease in the number of people being treated with HIV drugs compared to previous years, but as a growing proportion of patients is treated with single tablet regimens, the number of drugs sold is reduced. When looking at the number of persons treated with antiviral drugs, the antiviral treatment received by the highest number of patients are drugs used against herpes viruses. In 2021, the sale of antivirals against herpes virus, especially valaciclovir, increased even further. There was a decrease in the sales of agents against hepatitis C and influenza, while treatments for hepatitis B were unchanged. Influenza virus Similar to the previous influenza season, the season of 2021/2022 was also unusual, mainly due to the infection control measures implemented in response to the pandemic. There was a very low incidence of influenza at the beginning of the season, followed by a short period with significant spread of infection during the spring of 2021. No drug resistance against neuraminidase inhibitors was detected, but a mutation conferring resistance to the new drug baloxavir marboxil was found in one sample. Human immunodeficiency virus-1 The decreasing trend in the number of new HIV-infections has continued in 2021, which is also reflected in a reduction in the number of samples received for surveillance of primary drug resistance. A total of 64 samples were analysed as part of the surveillance in 2021, and only 13 of these were from patients infected in Norway. For the first time, we have been able to classify cases according to site of residence at the time of infection. Among those living in Norway at the time of infection, as much as 88% of the cases reported to MSIS were also reported to RAVN. This indicates that national routines for follow-up of newly diagnosed patients with regard to antiviral resistance are good. Resistance mutations were detected in 11% of the examined samples, which is comparable to previous years. In 2021, only mutations affecting reverse transcriptase inhibitors and none affecting protease inhibitors were found. Hepatitis B virus In 2021, a total of 134 samples with hepatitis B virus (HBV) were analysed for resistance mutations. Most of these samples (n=117) had been submitted to the reference laboratory for genotyping prior to treatment. These samples constitute the Norwegian surveillance of primary resistance. The remaining 17 samples were from patients with ongoing antiviral treatment and were submitted for investigation of resistance as a possible cause of treatment failure. Relevant resistance mutations were found in five of the 17 samples from patients with treatment failure. No resistance mutations were found in any of the surveillance samples. Human herpes viruses: Cytomegalovirus In 2021, 19 samples were submitted for resistance testing at the reference laboratory for cytomegalovirus (CMV). Relevant resistance mutations were detected in five of these samples. Low or moderate resistance to ganciclovir was found in four of these samples, while moderate resistance to the new drug maribavir was found in one sample. There is no systematic surveillance of resistance in CMV, and the true incidence of drug resistance cannot be determined. Human herpes viruses: Herpes simplex virus In 2021, only five samples with herpes simplex virus (HSV) were analysed for resistance. Two of the samples had mutations conferring resistance to aciclovir. Despite an increase in the use of aciclovir both as treatment and prophylaxis, samples are rarely submitted for resistance testing. Like CMV, there is no systematic surveillance of HSV drug resistance. Hepatitis C virus A systematic surveillance system for newly diagnosed HCV infections was launched in May 2022. In 2021, resistance testing was performed on a limited number of samples submitted for resistance testing. Drug resistance data is cross-referenced with epidemiological data from MSIS to enable comparisons of different subgroups. Resistance associated substitutions were detected in seven out of eight samples analysed for resistance, two of which were from treatment experienced patients, one sample was from a patient with no previous treatment exposure and the remaining four were from patients where treatment exposure was not known. SARS-CoV-2 Surveillance of antiviral resistance in SARS-CoV-2 has not been collected to RAVN in 2021. Oral drugs for the treatment of COVID-19 will be available in Norway from the autumn of 2022, and a system for surveillance of antiviral resistance will probably be implemented from the beginning of 2023. This surveillance will be based on the same sequence data that is part of the national monitoring of variants.

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