Concurrent Initiation of Hepatitis C and Opioid Use Disorder Treatment in People Who Inject Drugs

Abstract

Background: People who inject drugs have a high prevalence of hepatitis C virus (HCV) and significant disease associated with drug use; however, HCV treatment often occurs in absence of interventions to address opioid use disorder and drug use-related harms. The impact of concurrent initiation of opioid agonist therapy (OAT) on HCV treatment and drug use outcomes is unknown.

Methods: In this prospective, open-label, observational trial at a harm reduction organization's drop-in center in Washington, DC, 100 patients with chronic HCV infection, opioid use disorder, and ongoing injection drug use were treated with sofosbuvir-velpatasvir for 12-weeks and offered buprenorphine initiation. The primary end point was sustained virologic response (SVR), and secondary end points included uptake of and retention in OAT, change in risk behavior, and determinants of SVR.

Results: Eighty-two patients (82%) achieved SVR, which was not associated with baseline OAT status (P = .33), on-treatment drug use (P >.99), or imperfect daily adherence (P = .35) but was significantly associated with completing 2 or more 28-pill bottles of sofosbuvir-velpatasvir (P < .001) and receiving OAT at week 24 (P = .01). Of 67 patients not already receiving OAT at baseline, 53 (79%) started OAT. At week 24, 68 (68%) patients were receiving OAT. Receipt of OAT was associated with fewer opiate-positive urine drug screens (P = .003), lower human immunodeficiency virus risk-taking behavior scores (P < .001), and lower rates of opioid overdose (P = .04).

Conclusions: The Novel Model of Hepatitis C Treatment as an Anchor to Prevent HIV, Initiate Opioid Agonist Therapy, and Reduce Risky Behavior study demonstrates high uptake of buprenorphine collocated with HCV treatment, and it shows that concurrent initiation of OAT with HCV treatment can result in high rates of SVR while reducing risks associated with drug use.

Clinical trials registration: NCT03221309.

Keywords: HCV; IDU; OAT; OUD; PWID.

© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

Figures

Figure 1.

Patient enrollment and disposition. Abbreviation: SVR, sustained virologic response.

Figure 2.

Outcomes by opioid agonist therapy (OAT) uptake and retention. A, Sustained virologic response (SVR) by OAT uptake and retention. Patients receiving OAT at week 24 were significantly more likely to achieve SVR (P = .001) regardless of baseline OAT status. B, Opioid-positive urine drug screen results by study visit and OAT status. A significant decline in opioid-positive urine drug screens was seen in patients who started and were retained on OAT (P = .04) but not in other OAT groups. C, Change in the Darke HIV [human immunodeficiency virus] Risk-Taking Behavior Score (HRBS) by OAT status. A significant decline in drug use and total HRBS between day 0 and SVR was seen only in patients who started and were retained on OAT during hepatitis C virus (HCV) treatment (P < .001). D, Opioid overdose by OAT status at week 24. Kaplan-Meier curve of time to overdose from initiation of HCV to time of SVR determination, stratified by OAT status at week 24 (P = .046 by log-rank test).

Figure 3.

Opioid agonist therapy (OAT) status from screening to sustained virologic response (SVR). Sixty-seven (67%) of patients were not receiving OAT at baseline, of whom 49 (73%) started collocated buprenorphine, and 4 (6%) started noncollocated OAT. In addition, 3 (9%) patients receiving OAT at baseline transferred care to receive collocated buprenorphine. Of the 52 patients receiving collocated buprenorphine, 37 (71%) started during the first month of hepatitis C virus treatment, and 37 (71%) were retained at the SVR time point. Fifty-three (53%) patients started OAT after screening, of whom 38 (72%) were retained at SVR, and 15 (28%) discontinued OAT before SVR. At week 24, 68 (68%) patients were receiving OAT. Abbreviation: ANCHOR, A Novel Model of Hepatitis C Treatment as an Anchor to Prevent HIV, Initiate Opioid Agonist Therapy, and Reduce Risky Behavior.