scholarly journals Optimizing Hepatitis C Virus (HCV) Treatment in a US Colocated HCV/Opioid Agonist Therapy Program

2020 ◽  
Vol 7 (10) ◽  
Author(s):  
Jackie Habchi ◽  
Aurielle M Thomas ◽  
Sophie Sprecht-Walsh ◽  
Elenita Arias ◽  
Jeffrey Bratberg ◽  
...  
Keyword(s):  
United States ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Methadone Maintenance ◽  
The United States ◽  
Opioid Use ◽  
Agonist Therapy ◽  
Opioid Agonist ◽  
Opioid Agonist Therapy

Abstract Background A minority of patients with opioid use disorder are treated for hepatitis C virus infection (HCV). While colocated HCV and opioid agonist therapy (OAT) along with harm reduction can facilitate prevention and cascade to cure, there are few real-world examples of such embedded care models in the United States in the direct-acting antiviral (DAA) era. Methods We conducted a retrospective chart review to determine sustained virologic response (SVR) and reinfection rates during the first 5-year period of DAA availability among individuals tested and treated on-site at Rhode Island’s only nonprofit methadone maintenance program. Results Of 275 who initiated DAAs, the mean age (range) was 43 (22–71) years, 34.5% were female, 57.5% had genotype 1a, 23.3% had cirrhosis, and 92% were Medicaid recipients. SVR was 85.0% (232/273), while modified intent-to-treat SVR was 93.2% (232/249); 17 patients did not achieve SVR, 2 awaited SVR 12 weeks post-end-of-treatment, and 24 were lost to follow-up. Thirty reinfections were identified over 375.5 person-years of follow-up (rate, 7.99/100 person-years). The median time to first reinfection (interquartile range) was 128 (85.25–202.5) days. Before July 1, 2018, 72 patients accessed DAAs over 3.7 years; after Medicaid DAA restrictions were lifted, 109 patients accessed DAAs over 1.3 years. The Prior Authorization (PA) process requires many steps, differing across 11 RI insurers, taking 45–120 minutes per patient. Conclusions DAA treatment was effective among a marginalized population in an urban colocated OAT/HCV program. Removing DAA restrictions facilitates treatment initiation. The PA process remains a modifiable barrier to expanding capacity in the United States.

scholarly journals A Phylogenetic Analysis of Hepatitis C Virus Transmission, Relapse, and Reinfection Among People Who Inject Drugs Receiving Opioid Agonist Therapy

2020 ◽  
Vol 222 (3) ◽  
pp. 488-498 ◽  
Author(s):  
Matthew J Akiyama ◽  
Daniel Lipsey ◽  
Lilia Ganova-Raeva ◽  
Lili T Punkova ◽  
Linda Agyemang ◽  
...  
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Next Generation Sequencing ◽  
People Who Inject Drugs ◽  
Next Generation ◽  
Agonist Therapy ◽  
Opioid Agonist ◽  
Opioid Agonist Therapy ◽  
Generation Sequencing

Abstract Background Understanding hepatitis C virus (HCV) transmission among people who inject drugs (PWID) is essential for HCV elimination. We aimed to differentiate reinfections from treatment failures and to identify transmission linkages and associated factors in a cohort of PWID receiving opioid agonist therapy (OAT). Methods We analyzed baseline and follow-up specimens from 150 PWID from 3 OAT clinics in the Bronx, New York. Next-generation sequencing data from the hypervariable region 1 of HCV were analyzed using Global Hepatitis Outbreak and Surveillance Technology. Results There were 3 transmission linkages between study participants. Sustained virologic response (SVR) was not achieved in 9 participants: 7 had follow-up specimens with similar sequences to baseline, and 2 died. In 4 additional participants, SVR was achieved but the participants were viremic at later follow-up: 2 were reinfected with different strains, 1 had a late treatment failure, and 1 was transiently viremic 17 months after treatment. All transmission linkages were from the same OAT clinic and involved spousal or common-law partnerships. Conclusion This study highlights the use of next-generation sequencing as an important tool for identifying viral transmission and to help distinguish relapse and reinfection among PWID. Results reinforce the need for harm reduction interventions among couples and those who report ongoing risk factors after SVR.

scholarly journals Low Hepatitis C Reinfection Following Direct-acting Antiviral Therapy Among People Who Inject Drugs on Opioid Agonist Therapy

2019 ◽  
Vol 70 (12) ◽  
pp. 2695-2702 ◽  
Author(s):  
Matthew J Akiyama ◽  
Daniel Lipsey ◽  
Moonseong Heo ◽  
Linda Agyemang ◽  
Brianna L Norton ◽  
...  
Keyword(s):  
Hepatitis C ◽  
People Who Inject Drugs ◽  
Controlled Trial ◽  
Extension Study ◽  
Agonist Therapy ◽  
Opioid Agonist ◽  
Direct Acting Antiviral ◽  
Opioid Agonist Therapy ◽  
Direct Acting

Abstract Background Direct-acting antiviral (DAA) therapy is highly effective in people who inject drugs (PWID); however, rates, specific injection behaviors, and social determinants associated with hepatitis C virus (HCV) reinfection following DAA therapy among PWID on opioid agonist therapy (OAT) are poorly understood. Methods PREVAIL was a randomized controlled trial that assessed models of HCV care for 150 PWID on OAT. Those who achieved sustained virologic response (SVR) (n = 141; 94%) were eligible for this extension study. Interviews and assessments of recurrent HCV viremia occurred at 6-month intervals for up to 24 months following PREVAIL. We used survival analysis to analyze variables associated with time to reinfection. Results Of 141 who achieved SVR, 114 had a least 1 visit in the extension study (62% male; mean age, 52 years). Injection drug use (IDU) was reported by 19% (n = 22) in the extension study. HCV reinfection was observed in 3 participants. Over 246 person-years of follow-up, the incidence of reinfection was 1.22/100 person-years (95% CI, 0.25–3.57). All reinfections occurred among participants reporting ongoing IDU. The incidence of reinfection in participants reporting ongoing IDU (41 person-years of follow-up) was 7.4/100 person-years (95% CI, 1.5–21.6). Reinfection was associated with reporting ongoing IDU in the follow-up period (P < .001), a lack confidence in the ability to avoid contracting HCV (P < .001), homelessness (P = .002), and living with a PWID (P = .007). Conclusions HCV reinfection was low overall, but more common among people with ongoing IDU following DAA therapy on OAT, as well as those who were not confident in the ability to avoid contracting HCV, homeless, or living with a PWID. Interventions to mediate these risk factors following HCV therapy are warranted.

Expansion of buprenorphine opioid agonist therapy in the United States: Facility-level factors

2015 ◽  
Vol 146 ◽  
pp. e179
Author(s):  
Rosalie Liccardo Pacula ◽  
Adam J. Gordon ◽  
Andrew W. Dick ◽  
Rachel M. Burns ◽  
Carrie Farmer ◽  
...  
Keyword(s):  
United States ◽  
The United States ◽  
Agonist Therapy ◽  
Opioid Agonist ◽  
Opioid Agonist Therapy ◽  
Facility Level

scholarly journals Centrally acting stimulants in patients receiving opioid agonist therapy; a national prospective cohort study in Norway from 2015 to 2017

2019 ◽  
Author(s):  
Jørn Henrik Vold ◽  
Christer Aas ◽  
Svetlana Skurtveit ◽  
Ingvild Odsbu ◽  
Fatemeh Chalabianloo ◽  
...  
Keyword(s):  
Hepatitis C ◽  
Prescription Database ◽  
Opioid Use ◽  
Hepatitis C Infection ◽  
Agonist Therapy ◽  
Opioid Agonist ◽  
Opioid Agonist Therapy ◽  
Addictive Drugs ◽  
Adhd Treatment ◽  
Norwegian Prescription Database

Abstract Background It is estimated that about a third of patients on opioid agonist therapy (OAT) have Attention Deficit Hyperactivity Disorder (ADHD). Treatment by centrally acting sympathomimetics (CAS) is one of the essential approaches. This study evaluates the use of CAS in the Norwegian OAT population in the period from 2015 to 2017. Types and doses of CAS, and co-dispensations of other addictive drugs like benzodiazepines, z-hypnotics, gabapentinoids, and non-OAT opioids, as well as direct-acting antivirals (DAA) against hepatitis C infection, are evaluated. Methods Information about all dispensed CAS, OAT opioids, and the defined addictive drugs were recorded from the Norwegian Prescription Database. The number and the doses of dispensed drugs were used to estimate dispensation rates, the types, and the doses of dispensed CAS. Logistic regression analyses were employed to assess the associations between CAS and OAT opioid use, and dispensations of other addictive drugs and DAA against hepatitis C infection. Results A total of 9,235 OAT patients were included. The proportion of patients who used both CAS and OAT opioids increased from 4 % to 5 % during the study period. The three most dispensed CAS were methylphenidate (59 %), lisdexamphetamine (24 %), and dexamphetamine (17 %). Buprenorphine as OAT opioid (adjusted odds ratio: 1.59, CI: 1.24-2.05) was associated with being dispensed CAS. Among patients who received CAS annually throughout the study period, the dispensed doses of methylphenidate increased from 63 mg/day in 2015 to 76 mg/day in 2017 (p = 0.01). About 60 % of these patients were also dispensed other addictive drugs concomitantly in 2017. Conclusion Co-dispensation of CAS was low among patients on OAT in Norway, considering a higher prevalence of ADHD in this patient group. On the other hand, concurrent dispensations of multiple addictive drugs are common in this population. Understanding the underlying causes of such prescribing is essential, and research on how to optimize CAS treatment of people with ADHD receiving OAT is needed.

Elbasvir–Grazoprevir to Treat Hepatitis C Virus Infection in Persons Receiving Opioid Agonist Therapy

2016 ◽  
Vol 165 (9) ◽  
pp. 625 ◽  
Author(s):  
Gregory J. Dore ◽  
Frederick Altice ◽  
Alain H. Litwin ◽  
Olav Dalgard ◽  
Edward J. Gane ◽  
...  
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Virus Infection ◽  
Hepatitis C Virus Infection ◽  
Agonist Therapy ◽  
Opioid Agonist ◽  
Opioid Agonist Therapy

scholarly journals Concurrent Initiation of Hepatitis C and Opioid Use Disorder Treatment in People Who Inject Drugs

2020 ◽  
Vol 71 (7) ◽  
pp. 1715-1722 ◽  
Author(s):  
Elana S Rosenthal ◽  
Rachel Silk ◽  
Poonam Mathur ◽  
Chloe Gross ◽  
Rahwa Eyasu ◽  
...  
Keyword(s):  
Hepatitis C ◽  
Drug Use ◽  
People Who Inject Drugs ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Agonist Therapy ◽  
Hcv Treatment ◽  
Opioid Agonist ◽  
Opioid Agonist Therapy ◽  
The Impact

Abstract 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. Clinical Trials Registration NCT03221309.

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