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Treatment for hepatitis C virus infection among people who inject drugs attending opioid substitution treatment and community health clinics: the ETHOS Study
Author(s) -
Grebely Jason,
Alavi Maryam,
Micallef Michelle,
Dunlop Adrian J.,
Balcomb Anne C.,
Phung Nghi,
Weltman Martin D.,
Day Carolyn A.,
Treloar Carla,
Bath Nicky,
Haber Paul S.,
Dore Gregory J.
Publication year - 2016
Publication title -
addiction
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.424
H-Index - 193
eISSN - 1360-0443
pISSN - 0965-2140
DOI - 10.1111/add.13197
Subject(s) - medicine , ethos , opiate substitution treatment , harm reduction , opioid epidemic , opioid , injection drug use , drug , opioid use disorder , hepatitis c , psychiatry , buprenorphine , family medicine , virology , human immunodeficiency virus (hiv) , drug injection , receptor , political science , law
Aims To estimate adherence and response to therapy for chronic hepatitis C virus (HCV) infection among people with a history of injecting drug use. A secondary aim was to identify predictors of HCV treatment response. Design Prospective cohort recruited between 2009 and 2012. Participants were treated with peg‐interferon alfa‐2a/ribavirin for 24 (genotypes 2/3, G2/3) or 48 weeks (genotype 1, G1). Setting Six opioid substitution treatment (OST) clinics, two community health centres and one Aboriginal community‐controlled health organization providing drug treatment services in New South Wales, Australia. Participants Among 415 people with a history of injecting drug use and chronic HCV assessed by a nurse, 101 were assessed for treatment outcomes (21% female). Measurements Study outcomes were treatment adherence and sustained virological response (SVR, undetectable HCV RNA > 24 weeks post‐treatment). Findings Among 101 treated, 37% ( n = 37) had recently injected drugs (past 6 months) and 62% ( n = 63) were receiving OST. Adherence ≥ 80% was 86% ( n = 87). SVR was 74% (75 of 101), with no difference observed by sex (males: 76%, females: 67%, P = 0.662). In adjusted analysis, age < 35 (versus ≥ 45 years) [adjusted odds ratio (aOR) = 5.06, 95% confidence interval (CI) = 1.47, 17.40] and on‐treatment adherence ≥ 80% independently predicted SVR (aOR = 19.41, 95% CI = 3.61, 104.26]. Recent injecting drug use at baseline was not associated with SVR. Conclusions People with a history of injecting drug use and chronic hepatitis C virus attending opioid substitution treatment and community health clinics can achieve adherence and responses to interferon‐based therapy similar to other populations, despite injecting drugs at baseline. Younger age and adherence are predictive of improved response to hepatitis C virus therapy.