Concurrent Initiation of Hepatitis C and Opioid Use Disorder Treatment in People Who Inject Drugs
Concurrent Initiation of Hepatitis C and Opioid Use Disorder Treatment in People Who Inject Drugs
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DOI：
10.1093/cid/ciaa105
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发表时间：
2020-10-01
影响因子：
11.8
通讯作者：
Kattakuzhy, Sarah
中科院分区：
文献类型：
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作者：
Rosenthal, Elana S.;Silk, Rachel;Kattakuzhy, Sarah
背景。注射吸毒者丙型肝炎病毒 (HCV) 患病率较高，并且患有与吸毒相关的重大疾病；然而，HCV 治疗通常在缺乏解决阿片类药物使用障碍和药物使用相关危害的干预措施的情况下进行。同时开始阿片类激动剂治疗 (OAT) 对 HCV 治疗和药物使用结果的影响尚不清楚。方法。在华盛顿特区一家减害组织临时中心进行的这项前瞻性、开放标签、观察性试验中，100 名患有慢性 HCV 感染、阿片类药物使用障碍和持续注射吸毒的患者接受了为期 12 周的索磷布韦-维帕他韦治疗，并开始服用丁丙诺啡。主要终点是持续病毒学应答 (SVR)，次要终点包括 OAT 的摄取和保留、危险行为的变化以及 SVR 的决定因素。结果。 82 名患者 (82%) 实现了 SVR，这与基线 OAT 状态 (P = .33)、治疗中药物使用 (P > .99) 或日常依从性不理想 (P = .35) 无关，但与服用 2 瓶或更多 28 粒索磷布韦-维帕他韦 (P < .001) 并在第 24 周接受 OAT (P = .01) 显着相关。在 67 名基线时尚未接受 OAT 的患者中，53 名 (79%) 开始了 OAT。第 24 周时，68 名 (68%) 患者正在接受 OAT。接受 OAT 与较少的阿片类药物阳性尿液药物筛查 (P = .003)、较低的人类免疫缺陷病毒冒险行为评分 (P < .001) 以及较低的阿片类药物过量发生率 (P = .04) 相关。结论。丙型肝炎治疗作为预防 HIV、启动阿片类激动剂治疗和减少危险行为的锚定新模型研究表明，丁丙诺啡与 HCV 治疗结合使用的比例较高，并且同时启动 OAT 与 HCV 治疗可导致较高的 SVR 率，同时降低与药物使用相关的风险。
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.