HIV Serostatus Affects Hepatitis C Virus Care Cascade

While initiation and maintenance on medication to treat opioid use disorder were high, subsequent confirmatory hepatitis C virus testing was poor among participants without HIV.

Individuals with HIV who are prescribed medication to treat opioid use disorder (MOUD) receive more follow-up testing for hepatitis C virus (HCV), but treatment for HCV is similar to those without HIV. Opioid injection drug use (IDU) rates are also reduced more in participants without HIV who are prescribed MOUD. These study findings were published in Open Forum Infectious Diseases.

Researchers performed a secondary analysis of the Project MAT BIO and Persistence observational cohort studies of individuals (N=129) with or without HIV with a diagnosis of OUD who initiated treatment with methadone, buprenorphine, or naltrexone. The primary outcome was to identify the number of participants who completed the HCV cascade. The secondary outcomes included changes in opioid IDU and stimulant use by HIV serostatus from baseline to 90 days after initiation of MOUD.

Chi-squared tests determined if HIV status affected progression through the HCV cascade. Generalized linear regression models were used to establish changes of self-reported opioid IDU and stimulant use from baseline. A compound symmetry covariance structure determined correlations between participants.

The majority of the participants were male (72.1%, P=0.003) and White (58.9%). Participants’ HCV antibody serostatus was significant (n=78, 60.5%), especially among those with HIV (83.3%, n=40). Most participants (86.8%, n=112) used opioids within 3 months before enrolling in the study.

Improved integration of concomitant OUD with HCV and HIV screening, linkage to care, and treatment are needed for persons without HIV.

Participants without HIV experienced a lower rate of follow-up HCV viral load testing (43.3% vs 76.5%, P =0.03). Positive opioid urine toxicology results decreased over 90 days (61.4% to 38.0%, P <.001). There was no significant difference when stratified by HIV serostatus (49.9% to 32.9%). There was no significant decline in stimulant use among the cohort from baseline to 90 days after initiation of MOUD. Participants’ HIV statuses did not influence the results.

Limitations of this study include a small sample size and shorter follow-up durations in the parent trials. The researchers note the inability to compare the effect MOUD had on minimizing opioid IDU because a control group was not used.

According to researchers, “Improved integration of concomitant OUD with HCV and HIV screening, linkage to care, and treatment are needed for persons without HIV.”

Disclosure: This research was supported by National Institute on Drug Abuse.

One study author declared affiliations with a pharmaceutical company. Please see the original reference for a full list of disclosures.

References:

Lier AJ, Vander Wyk B, Di Paola A, Springer SA. Evaluation of the impact of HIV serostatus on the hepatitis C virus care cascade and injection drug use among persons initiating medication treatment for opioid use disorder. Open Forum Infectious Diseases. Published online November 14, 2022. doi:10.1093/ofid/ofac624