Association between opioid agonist therapy and testing, treatment uptake, and treatment outcomes for hepatitis C infection among people who inject drugs: A systematic review and meta-analysis

Abstract Background People who inject drugs (PWID) experience barriers to accessing testing and treatment for hepatitis C virus (HCV) infection. Opioid agonist therapy (OAT) may provide an opportunity to improve access to HCV care. This systematic review assessed the association of OAT and HCV testing, treatment, and treatment outcomes among PWID. Methods Bibliographic databases and conference presentations were searched for studies assessing the association between OAT and HCV testing, treatment, and treatment outcomes [direct-acting antiviral (DAA) therapy only] among people who inject drugs (in the past year). Meta-analysis was used to pool estimates. Results Among 9,877 articles identified, 22 studies conducted in Australia, Europe, North America, and Thailand were eligible and included. Risk of bias was serious in 21 studies and moderate in one study. Current/recent OAT was associated with an increased odds of recent HCV antibody testing [4 studies; odds ratio (OR), 1.80; 95% CI:1.36, 2.39), HCV RNA testing among those who were HCV antibody positive (2 studies; OR, 1.83; 95% CI:1.27, 2.62), and DAA treatment uptake among those who were HCV RNA positive (7 studies; OR 1.53; 95% CI: 1.07, 2.20). There was insufficient evidence of an association between OAT and treatment completion (9 studies) or sustained virologic response following DAA therapy (9 studies). Conclusions Opioid agonist therapy can increase linkage to HCV care, including uptake of HCV testing and treatment among PWID. This supports the scale-up of OAT as part of strategies to enhance HCV treatment to further HCV elimination efforts.

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HIV And HCV adherence and treatment outcomes among people who inject drugs receiving opioid agonist therapy

AIDS Care ◽

10.1080/09540121.2021.1973659 ◽

2021 ◽

pp. 1-5

Author(s):

Hadi J Minhas ◽

Matthew J. Akiyama ◽

Brianna L. Norton ◽

Moonseong Heo ◽

Julia H. Arnsten ◽

...

Keyword(s):

Treatment Outcomes ◽

People Who Inject Drugs ◽

Agonist Therapy ◽

Opioid Agonist ◽

Opioid Agonist Therapy

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Factors associated with physical and sexual violence by police among people who inject drugs in Ukraine: implications for retention on opioid agonist therapy

Journal of the International AIDS Society ◽

10.7448/ias.19.4.20897 ◽

2016 ◽

Vol 19 ◽

pp. 20897 ◽

Cited By ~ 17

Author(s):

Oksana Kutsa ◽

Ruthanne Marcus ◽

Martha J Bojko ◽

Alexei Zelenev ◽

Alyona Mazhnaya ◽

...

Keyword(s):

Sexual Violence ◽

People Who Inject Drugs ◽

Agonist Therapy ◽

Opioid Agonist ◽

Factors Associated ◽

Opioid Agonist Therapy

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Low Hepatitis C Reinfection Following Direct-acting Antiviral Therapy Among People Who Inject Drugs on Opioid Agonist Therapy

Clinical Infectious Diseases ◽

10.1093/cid/ciz693 ◽

2019 ◽

Vol 70 (12) ◽

pp. 2695-2702 ◽

Cited By ~ 14

Author(s):

Matthew J Akiyama ◽

Daniel Lipsey ◽

Moonseong Heo ◽

Linda Agyemang ◽

Brianna L Norton ◽

...

Keyword(s):

Hepatitis C ◽

People Who Inject Drugs ◽

Controlled Trial ◽

Extension Study ◽

Agonist Therapy ◽

Opioid Agonist ◽

Direct Acting Antiviral ◽

Opioid Agonist Therapy ◽

Direct Acting

Abstract Background Direct-acting antiviral (DAA) therapy is highly effective in people who inject drugs (PWID); however, rates, specific injection behaviors, and social determinants associated with hepatitis C virus (HCV) reinfection following DAA therapy among PWID on opioid agonist therapy (OAT) are poorly understood. Methods PREVAIL was a randomized controlled trial that assessed models of HCV care for 150 PWID on OAT. Those who achieved sustained virologic response (SVR) (n = 141; 94%) were eligible for this extension study. Interviews and assessments of recurrent HCV viremia occurred at 6-month intervals for up to 24 months following PREVAIL. We used survival analysis to analyze variables associated with time to reinfection. Results Of 141 who achieved SVR, 114 had a least 1 visit in the extension study (62% male; mean age, 52 years). Injection drug use (IDU) was reported by 19% (n = 22) in the extension study. HCV reinfection was observed in 3 participants. Over 246 person-years of follow-up, the incidence of reinfection was 1.22/100 person-years (95% CI, 0.25–3.57). All reinfections occurred among participants reporting ongoing IDU. The incidence of reinfection in participants reporting ongoing IDU (41 person-years of follow-up) was 7.4/100 person-years (95% CI, 1.5–21.6). Reinfection was associated with reporting ongoing IDU in the follow-up period (P < .001), a lack confidence in the ability to avoid contracting HCV (P < .001), homelessness (P = .002), and living with a PWID (P = .007). Conclusions HCV reinfection was low overall, but more common among people with ongoing IDU following DAA therapy on OAT, as well as those who were not confident in the ability to avoid contracting HCV, homeless, or living with a PWID. Interventions to mediate these risk factors following HCV therapy are warranted.

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Management of mood and anxiety disorders in patients receiving opioid agonist therapy: Review and meta-analysis

American Journal on Addictions ◽

10.1111/ajad.12581 ◽

2017 ◽

Vol 26 (6) ◽

pp. 551-563 ◽

Cited By ~ 12

Author(s):

Ahmed N. Hassan ◽

Aaron S. Howe ◽

Andriy V. Samokhvalov ◽

Bernard Le Foll ◽

Tony P. George

Keyword(s):

Anxiety Disorders ◽

Meta Analysis ◽

Agonist Therapy ◽

Opioid Agonist ◽

Opioid Agonist Therapy ◽

Mood And Anxiety Disorders

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Integrated treatment of hepatitis C virus infection among people who inject drugs: study protocol for a randomised controlled trial (INTRO-HCV)

BMC Infectious Diseases ◽

10.1186/s12879-019-4598-7 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 5

Author(s):

Lars T. Fadnes ◽

◽

Christer Frode Aas ◽

Jørn Henrik Vold ◽

Christian Ohldieck ◽

...

Keyword(s):

Standard Care ◽

People Who Inject Drugs ◽

Integrated Treatment ◽

Agonist Therapy ◽

Hcv Treatment ◽

Opioid Agonist ◽

Opioid Agonist Therapy ◽

Disorder Treatment ◽

Randomised Controlled

Abstract 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. Trial registration ClinicalTrials.gov.no. NCT03155906.

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Intensive Models of Hepatitis C Care for People Who Inject Drugs Receiving Opioid Agonist Therapy

Annals of Internal Medicine ◽

10.7326/m18-1715 ◽

2019 ◽

Vol 170 (9) ◽

pp. 594 ◽

Cited By ~ 31

Author(s):

Matthew J. Akiyama ◽

Brianna L. Norton ◽

Julia H. Arnsten ◽

Linda Agyemang ◽

Moonseong Heo ◽

...

Keyword(s):

Hepatitis C ◽

People Who Inject Drugs ◽

Agonist Therapy ◽

Opioid Agonist ◽

Opioid Agonist Therapy

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A Phylogenetic Analysis of Hepatitis C Virus Transmission, Relapse, and Reinfection Among People Who Inject Drugs Receiving Opioid Agonist Therapy

The Journal of Infectious Diseases ◽

10.1093/infdis/jiaa100 ◽

2020 ◽

Vol 222 (3) ◽

pp. 488-498 ◽

Cited By ~ 1

Author(s):

Matthew J Akiyama ◽

Daniel Lipsey ◽

Lilia Ganova-Raeva ◽

Lili T Punkova ◽

Linda Agyemang ◽

...

Keyword(s):

Hepatitis C Virus ◽

Hepatitis C ◽

Next Generation Sequencing ◽

People Who Inject Drugs ◽

Next Generation ◽

Agonist Therapy ◽

Opioid Agonist ◽

Opioid Agonist Therapy ◽

Generation Sequencing

Abstract Background Understanding hepatitis C virus (HCV) transmission among people who inject drugs (PWID) is essential for HCV elimination. We aimed to differentiate reinfections from treatment failures and to identify transmission linkages and associated factors in a cohort of PWID receiving opioid agonist therapy (OAT). Methods We analyzed baseline and follow-up specimens from 150 PWID from 3 OAT clinics in the Bronx, New York. Next-generation sequencing data from the hypervariable region 1 of HCV were analyzed using Global Hepatitis Outbreak and Surveillance Technology. Results There were 3 transmission linkages between study participants. Sustained virologic response (SVR) was not achieved in 9 participants: 7 had follow-up specimens with similar sequences to baseline, and 2 died. In 4 additional participants, SVR was achieved but the participants were viremic at later follow-up: 2 were reinfected with different strains, 1 had a late treatment failure, and 1 was transiently viremic 17 months after treatment. All transmission linkages were from the same OAT clinic and involved spousal or common-law partnerships. Conclusion This study highlights the use of next-generation sequencing as an important tool for identifying viral transmission and to help distinguish relapse and reinfection among PWID. Results reinforce the need for harm reduction interventions among couples and those who report ongoing risk factors after SVR.

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Uptake and predictors of direct-acting antiviral treatment for hepatitis C among people receiving opioid agonist therapy in Sweden and Norway: a drug utilization study from 2014 to 2017

10.21203/rs.3.rs-18790/v2 ◽

2020 ◽

Author(s):

Christer F. Aas ◽

Jørn Henrik Vold ◽

Svetlana Skurtveit ◽

Ingvild Odsbu ◽

Fatemeh Chalabianloo ◽

...

Keyword(s):

Hepatitis C ◽

Antiviral Treatment ◽

Prescription Database ◽

Agonist Therapy ◽

Hcv Treatment ◽

Opioid Agonist ◽

Direct Acting Antiviral ◽

Opioid Agonist Therapy ◽

Treatment Uptake ◽

Direct Acting

Abstract Background: Treatment with direct-acting antiviral agents (DAAs) offers an opportunity to eliminate hepatitis C virus (HCV) endemic among people who inject drugs (PWID) and people enrolled in opioid agonist therapy (OAT) programs. The objective of this study was to estimate and to compare HCV treatment uptake after the introduction of DAAs among patients receiving OAT in Sweden and Norway. We also aimed to evaluate predictors of DAAs treatment among OAT patients in both countries.Methods: This observational study was conducted with data from The Swedish Prescribed Drug Register and The Norwegian Prescription Database. We studied dispensed medications to calculate HCV treatment among OAT patients from 2014 to 2017 in Sweden and Norway. HCV prevalence was estimated from primary and secondary sources. Dispensations of medicines from different therapeutic areas, which served as proxy for co-morbidities in 2017, were conditionally adjusted for age, gender, and OAT medications. Logistic regression was used to evaluate these parameters. Results: In total 3,529 individuals were identified with dispensed OAT in the Swedish cohort and 7,739 individuals in the Norwegian cohort. HCV treatment was utilized by 407 persons in Sweden and 920 in Norway during the study period. Annual HCV and DAA treatment uptake increased in both countries. The estimated cumulative HCV treatment uptake at the end of 2017 was 31% in Norway and 28% in Sweden. DAA treatment was associated with increased age (aOR 1.8; 95% CI 1.0-3.2) and the dispensation of drugs used for diabetes (aOR 3.2; 95% CI 1.8-5.7) in Sweden. In Norway, lipid modifying agents and antibacterials were associated with decreased odds (aOR 0.4; 95%CI 0.2-0.9, aOR 0.8; 95%CI 0.6-1.0).Conclusions: An increase in DAA treatment and HCV treatment uptake was observed among Swedish and Norwegian OAT patients whilst introducing new direct-acting antiviral treatment regimens. However, more than two thirds of the OAT population in Norway and Sweden were untreated at the beginning of 2018. A further scale-up is crucial in order to control and eliminate the HCV endemic among OAT patients.

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