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 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.

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