Beginning treatment for hepatitis C virus (HCV) infection concurrently with opioid agonist therapy can result in high rates of sustained virologic response while reducing drug use risks, according to data published in Clinical Infectious Diseases.
There is a high prevalence of HCV among people who inject drugs along with significant morbidity associated with such drug use. In the prospective, open-label, observational trial (ANCHOR; ClinicalTrial.gov: NCT03221309), the effects of concurrent HCV and OAT treatment were investigated.
The trial was conducted at a drop-in center in Washington, DC, where 100 patients with chronic HCV, opioid use disorder, and ongoing injection drug-use were recruited. Participants were treated with sofosbuvir/velpatasvir for 12-weeks and offered buprenorphine initiation.
A total of 82 participants achieved the primary endpoint of sustained virologic response. This outcome was not associated with baseline opioid agonist therapy status (P =.4), on-treatment drug use (P =1.00), or imperfect daily adherence (P =.35). It was, however, significantly associated with completing 2 or more bottles of sofosbuvir/velpatasvir (P =.0001) and receiving opioid agonist therapy at week 24 (P =.001). There were 67 patients not receiving baseline opioid agonist therapy and of these, 53 initiated this therapy.
At week 24, 68 patients were receiving opioid agonist therapy. Outcomes associated with receiving opioid agonist therapy included fewer opiate-positive urine drug screens (P =.003), lower HIV risk-taking behavior scores (P <.0001), and lower rates of opioid overdose (P =.04).
The study results are limited in generalizability due to it taking place at a single center and employing a single direct acting antiviral. It was also deemed unethical to withhold opioid agonist therapy access in this population, meaning that while outcomes were assessed based on receipt status, the groups were self-selected rather than randomly assigned. Causation could not be demonstrated either; therefore, it is possible that factors associated with non-uptake or opioid agonist therapy discontinuation were also responsible for HCV treatment failure or loss to follow-up. In addition, this population only represented one subset of a larger epidemic that includes a variable landscape of drug use. Finally, investigators noted that federal restrictions limited their ability to offer collocated opioid agonist therapy with methadone, which may have been of benefit in some patients. They believe that in the future it would be beneficial to replicate this model in different demographic populations and using different opioid use disorder treatment modalities.
Investigators concluded that the ANCHOR data demonstrate it is possible to achieve high rates of HCV cure and reduced drug use associated risks by initiating opioid agonist therapy and HCV treatment concurrently in people abusing opioids and injecting drugs. They further found that the high uptake of collocated buprenorphine in those not on opioid agonist therapy meant that HCV treatment can be the moment to engage people who inject drugs in evidence-based treatment for opioid use disorder. For investigators, increased engagement of medical providers and expansions of access to treatment for HCV and opioid use disorders is needed to optimize health, reduce harm, and interrupt HCV transmission in this high-risk, marginalized population.
Disclosure: This study was in part supported by Gilead Sciences. Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
Rosenthal ES, Silk R, Mathur P, et al. Concurrent initiation of hepatitis C and opioid use disorder treatment in people who inject drugs [published online February 3, 2020]. Clin Infect Dis. doi:10.1093/cid/ciaa105