Monitoring hepatitis C virus treatment rates in an Opioid Treatment Program: A longitudinal study

Abstract

Direct-acting antiviral agents; Opioid Treatment Program; Opioid agonist therapy; Hepatitis C virus infection; Human immunodeficiency virus infection; Drug use

Agentes antivirales de acción directa; Programa de Tratamiento de Opioides; Terapia con agonistas opioides; Infección por el virus de la hepatitis C; Infección por el virus de la inmunodeficiencia humana; Uso de drogas

Agents antivirals d'acció directa; Programa de tractament amb opioides; Teràpia amb agonistes opioides; Infecció pel virus de l'hepatitis C; Infecció pel virus de la immunodeficiència humana; Ús de drogues

Background: Direct-acting antivirals (DAAs) are recommended for the treatment of hepatitis C virus (HCV) infection in patients treated with methadone or buprenorphine.

Aim: To assess HCV treatment rates in an Opioid Treatment Program (OTP).

Methods: This longitudinal study included 501 patients (81.4% men, median age: 45 years; interquartile range: 39-50 years) enrolled in an OTP between October 2015 and September 2017. Patients were followed until September 2019. Data on socio-demographics, substance use, HCV infection, human immunodeficiency virus (HIV) infection and laboratory parameters were collected at entry. We analyzed medical records to evaluate HCV treatment. Kaplan-Meier methods and Cox regression models were used to analyze the DAA treatment uptake and to identify treatment predictors.

Results: Prevalence of HCV and HIV infection was 70% and 34%, respectively. Among anti-HCV-positive (n = 336) patients, 47.2%, 41.3%, and 31.9% used alcohol, cannabis, and cocaine, respectively. HCV-RNA tests were positive in 233 (69.3%) patients. Twentyeight patients (8.3%) cleared the infection, and 59/308 (19.1%) had received interferon-based treatment regimens before 2015. Among 249 patients eligible, 111 (44.6%) received DAAs. Treatment rates significantly increased over time from 7.8/100 person-years (p-y) (95%CI: 5.0-12.3) in 2015 to 18.9/100 p-y (95%CI: 11.7-30.3) in 2019. In a multivariate analysis, patients with HIV co-infection were twice as likely to receive DAAs (HR = 1.94, 95%CI: 1.21-3.12) than patients with HCV mono-infection. Current drug use was an independent risk factor for not receiving treatment against infection (HR = 0.48, 95%CI: 0.29-0.80).

Conclusion: HCV treatment is evolving in patients with HCV-HIV co-infection. Ongoing drug use while in an OTP might negatively impact the readiness to treat infection.

Supported by the Ministry of Science, Innovation and Universities, Carlos III Health Institute (ISCIII), European Fund for Regional Development (FEDER), Network for Cooperative Research in Health (RETICS), Spain (No. RD16/0017/0003, PI17/00174, INT19/00026, CD19/00019); the Ministry of Health, National Plan on Drugs (PNSD), Spain (No. 2018/020); the European Commission (806996- JUSTSO-JUST2017-AG-DRUG); the Gilead Fellowship Program, Gilead Sciences (No. GLD17/187); the Ministry of Education, Spain (No. PRX18/00245); the Agency for Management of University and Research Grants, Government of Catalonia (No. 2017SGR316); and the Municipal Institute of Personal Services-IMSP, Badalona.