Among those with chronic hepatitis C virus (HCV) infection who were receiving opioid agonist therapy or who had a recent history of injecting drugs, over 2 years, alcohol and drug use remained unchanged or decreased slightly, while needle sharing decreased gradually yet significantly during and after treatment with direct-acting antiviral (DAA) medications, according to a report published in Clinical Infectious Diseases.
Despite improvements in the efficacy and ease of administration of HCV therapies in recent years, and contrary to current guidelines, intravenous drug use often remains an impediment to efficient provision of DAA medications to people who inject drugs (PWID). A lack of prior research led investigators to explore longitudinal patterns of drug and alcohol use and equipment sharing risk behaviors in this population, which according to researchers is the first study to examine such trends during and following DAA treatment.
A pooled analysis of 190 adult participants (mean age, 47 years; 74% men) considered data from 2 separate international, multicenter, single-arm, open-label, phase 4 trials — SIMPLIFY (n=103) and D3FEAT (n=87) — that assessed the safety and efficacy of DAA therapies for HCV in those undergoing opioid agonist therapy or with a history of injection within 6 months and the impact on clinical and nonclinical outcomes (ClinicalTrials.gov identifier: NCT02336139 and NCT02498015, respectively). Patients were treated for 12 weeks with sofosbuvir/velpatasvir (SIMPLIFY) or paritepravir/ritonavir/dasabuvir/ombitasvir ± ribavirin (D3FEAT) and completed a behavioral questionnaire at screening, during treatment, and during posttreatment follow-up through 2 years and 10 visits.
The primary outcomes were changes in 5 behavioral measures, including injection of any substance, opioid and stimulant injection, sharing of injection equipment, and alcohol use; the main exposure was time during and after treatment. Alcohol use was scored 1 to 12 on the Alcohol Use Disorders Identification Test-Consumption, with higher scores indicating more hazardous drinking. Generalized estimating equations and logistic regression analysis were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs).
At screening prior to treatment, a majority of patients were receiving opioid agonist therapy (61%) or reported injection drug use within the previous month (62%); 47% and 39% reported injecting opioids and stimulants, respectively. There were 28 (16%) people who admitted to sharing injection equipment over the previous month. The median Alcohol Use Disorders Identification Test-Consumption score was 2.
Across 2 years of follow-up, none of the 5 outcome measures increased. There was a modest reduction of any injection drug use over the previous month, with each visit seeing a 4% drop (OR 0.96; 95% CI, 0.92-0.99; P =.02). Previous month opioid injections also decreased slightly (OR 0.95; 95% CI, 0.92-0.99; P =.01), while previous month needle sharing decreased gradually and more substantially, with incremental reductions of 13% on average at each subsequent visit (OR 0.87; 95% CI, 0.80-0.94; P <.01). Injection of stimulants (OR 0.98; 95% CI, 0.94-1.02; P =.33) and alcohol consumption (OR 0.99; 95% CI, 0.95-1.04; P =.75) within the previous month both remained stable without significant changes.
Study limitations included an inability to attribute changes to any one intervention owing to lack of a comparison group of PWID who did not receive DAA therapy, self-reported data subject to recall bias, possible losses to follow-up, and potential nongeneralizability of the results to all PWID.
“These findings further support expanding HCV treatment to all infected PWID, irrespective of ongoing injection drug use,” noted the authors. They recommended that future research aim to clarify which HCV interventions specifically promote reductions in needle sharing.
Funding and Conflicts of Interest Disclosures:
Please see original article for funding and conflict of interest information.
Artenie AA, Cunningham EB, Dore GJ, et al. Patterns of drug and alcohol use and injection equipment sharing among people with recent injecting drug use or receiving opioid agonist treatment during and following hepatitis C virus treatment with direct-acting antiviral therapies: an international study [published online July 11, 2019]. Clin Infect Dis. doi:10.1093/cid/ciz633