Comment on the updated AASLD practice guidelines for the diagnosis, management, and treatment of hepatitis C: Treating active drug users #

Swan, Tracy; Curry, Jen

doi:10.1002/hep.23077

Cited by 5 publications

(7 citation statements)

References 11 publications

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“…Further, IDU prior to, and during, PEG-IFN treatment was not associated with reduced adherence or treatment completion. These data suggest that adherence is not compromised among IDUs, supporting guidelines that active IDUs should not be excluded from HCV therapy and the decision to initiate HCV treatment in active IDUs should be made case by case [35-37]. Decreased adherence was associated primarily with level of education, and to a lesser extent with other socio behavioural factors.…”

Section: Discussionsupporting

confidence: 53%

Adherence to treatment for recently acquired hepatitis C virus (HCV) infection among injecting drug users

Grebely

Matthews

Hellard

et al. 2011

Journal of Hepatology

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Section: Discussionsupporting

confidence: 53%

Adherence to treatment for recently acquired hepatitis C virus (HCV) infection among injecting drug users

Grebely

Matthews

Hellard

et al. 2011

Journal of Hepatology

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“…Further, injecting drug use both prior to and during treatment was not associated with reduced adherence to therapy or treatment completions. These data suggest that adherence to HCV therapy among HCV infected PWID is not compromised by ongoing injection drug use and supports guidelines which suggest that active PWID should not be excluded from therapy; rather decisions should be made on a case-by-case basis [27–30]. Further studies are needed to characterize adherence to interferon-free DAA therapies among PWID and those receiving OST to better understand whether adherence is actually a problem in this population in the DAA era.…”

Section: Discussionsupporting

confidence: 63%

“…In unadjusted analyses, potential predictors were determined a priori and included sex, age, education, accommodation, employment, current OST treatment, social functioning, current depression, alcohol consumption, injection drug use at baseline (past month), injecting behaviours (frequency and drug injected), and treatment arm. Social functioning was calculated using a validated scale from the Opiate Treatment Index [27] that addresses employment, residential stability, and inter-personal conflict as well as social support. A higher score reflects poorer social functioning.…”

Section: Methodsmentioning

confidence: 99%

“…A higher score reflects poorer social functioning. This scale has been validated among opiate users in Australia (range, 0–48) [27]. All variables with p < 0.20 in the bivariate analysis were considered for multivariate logistic regression models using a backward stepwise approach, sequentially eliminated and subject to the result of a likelihood ratio test.…”

Section: Methodsmentioning

confidence: 99%

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Adherence to response-guided pegylated interferon and ribavirin for people who inject drugs with hepatitis C virus genotype 2/3 infection: the ACTIVATE study

et al. 2017

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BackgroundThe aims of this analysis were to investigate treatment completion and adherence among people with ongoing injecting drug use or receiving opioid substitution therapy (OST) in a study of response-guided therapy for chronic HCV genotypes 2/3 infection.MethodsACTIVATE was a multicenter clinical trial recruited between 2012 and 2014. Participants with genotypes 2/3 were treated with directly observed peg-interferon alfa-2b (PEG-IFN) and self-administered ribavirin for 12 (undetectable HCV RNA at week 4) or 24 weeks (detectable HCV RNA at week 4). Outcomes included treatment completion, PEG-IFN adherence, ribavirin adherence, and sustained virological response (SVR, undetectable HCV RNA >12 weeks post-treatment).ResultsAmong 93 people treated, 59% had recently injected drugs (past month), 77% were receiving OST and 56% injected drugs during therapy. Overall, 76% completed treatment. Mean on-treatment adherence to PEG-IFN and ribavirin were 98.2% and 94.6%. Overall, 6% of participants missed >1 dose of PEG-IFN and 31% took <95% of their prescribed ribavirin., Higher treatment completion was observed among those receiving 12 vs. 24 weeks of treatment (97% vs. 46%, P < 0.001) while the proportion of participants with 95% on-treatment ribavirin adherence was similar between groups (67% vs. 72%, P = 0.664). Receiving 12 weeks of therapy was independently associated with treatment completion. No factors were associated with 95% RBV adherence. Neither recent injecting drug use at baseline nor during therapy was associated with treatment completion or adherence to ribavirin. In adjusted analysis, treatment completion was associated with SVR (aOR 23.9, 95% CI 2.9–193.8).ConclusionsThis study demonstrated a high adherence to directly observed PEG-IFN and self-administered ribavirin among people with ongoing injecting drug use or receiving OST. These data also suggest that shortening therapy from 24 to 12 weeks can lead to improved treatment completion. Treatment completion was associated with improved response to therapy.ACTIVATE trial registration number: NCT01364090 - May 31, 2011Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-017-2517-3) contains supplementary material, which is available to authorized users.

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“…Current National Institutes of Health (2002) and professional guidelines call for increased access to antiviral therapy for HCV patients with substance use and psychiatric comorbidities (Garcia-Tsao and Lim 2009; Swan and Curry 2009). Within recent years, amphetamine-type stimulants have become the second most widely used group of illicit drugs worldwide (UNODC, 2012).…”

Section: Discussionmentioning

confidence: 99%

Characteristics and Impact of Methamphetamine Use in Patients With Chronic Hepatitis C

Riley

Liu

Cohen

et al. 2014

Journal of Addiction Medicine

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Objectives Methamphetamine (MA) use has increased in the United States in the last 20 years and is a risk factor for hepatitis C virus(HCV) infection. The purpose of this study was to determine the characteristics and HCV infection outcomes of patients with a history of MA use. Methods Subjects consisted of newly entered patients in the Veterans Affairs (VA) HCV registry at a single VA medical center from January 1, 2004, to June 30, 2004, and from January 1, 2007, to June 30, 2007. Univariate and multivariate analyses related to HCV infection antiviral treatment outcomes through 2010 was performed. Results A total of 198 consecutive eligible HCV registry patients were analyzed, and 40% had a history of MA use. Of patients with MA use history, 46% (36/79) had active use (within 6 months) at initial contact. Active MA users were significantly younger (mean age, 45.5 years), with more concomitant drug use (86%), compared with patients without MA use (mean age, 53.5 years; 42% minority; 29% other drug use). Overall, 71% of the 198 patients reported a history of problematic alcohol use, and 47% of those reported active abuse. Logistic regression analyses indicated that MA use did not significantly adversely affect antiviral treatment initiation, completion, or sustained virological response rates compared with that in patients without MA use. Active alcohol users had lower treatment initiation than patients without alcohol use. Conclusions MA use is common in recent US veterans with HCV infection and occurs in younger patients with polysubstance use. Prior history or active MA use does not seem to adversely affect HCV infection clinic treatment compared with that in HCV patients without MA use.

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Comment on the updated AASLD practice guidelines for the diagnosis, management, and treatment of hepatitis C: Treating active drug users #

Cited by 5 publications

References 11 publications

Adherence to treatment for recently acquired hepatitis C virus (HCV) infection among injecting drug users

Adherence to treatment for recently acquired hepatitis C virus (HCV) infection among injecting drug users

Adherence to response-guided pegylated interferon and ribavirin for people who inject drugs with hepatitis C virus genotype 2/3 infection: the ACTIVATE study

Characteristics and Impact of Methamphetamine Use in Patients With Chronic Hepatitis C

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