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Sanvisens A, Rivas I, Faure E, Espinach N, Hernandez-Rubio A, Majó X, Colom J, Muga R. Monitoring hepatitis C virus treatment rates in an Opioid Treatment Program: A longitudinal study. World J Gastroenterol 2020; 26:5874-5883. [PMID: 33132641 PMCID: PMC7579757 DOI: 10.3748/wjg.v26.i38.5874] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/12/2020] [Accepted: 09/17/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Direct-acting antivirals (DAAs) are recommended for the treatment of hepatitis C virus (HCV) infection in patients treated with methadone or buprenorphine.
AIM To assess HCV treatment rates in an Opioid Treatment Program (OTP).
METHODS This longitudinal study included 501 patients (81.4% men, median age: 45 years; interquartile range: 39-50 years) enrolled in an OTP between October 2015 and September 2017. Patients were followed until September 2019. Data on socio-demographics, substance use, HCV infection, human immunodeficiency virus (HIV) infection and laboratory parameters were collected at entry. We analyzed medical records to evaluate HCV treatment. Kaplan-Meier methods and Cox regression models were used to analyze the DAA treatment uptake and to identify treatment predictors.
RESULTS Prevalence of HCV and HIV infection was 70% and 34%, respectively. Among anti-HCV-positive (n = 336) patients, 47.2%, 41.3%, and 31.9% used alcohol, cannabis, and cocaine, respectively. HCV-RNA tests were positive in 233 (69.3%) patients. Twentyeight patients (8.3%) cleared the infection, and 59/308 (19.1%) had received interferon-based treatment regimens before 2015. Among 249 patients eligible, 111 (44.6%) received DAAs. Treatment rates significantly increased over time from 7.8/100 person-years (p-y) (95%CI: 5.0-12.3) in 2015 to 18.9/100 p-y (95%CI: 11.7-30.3) in 2019. In a multivariate analysis, patients with HIV co-infection were twice as likely to receive DAAs (HR = 1.94, 95%CI: 1.21-3.12) than patients with HCV mono-infection. Current drug use was an independent risk factor for not receiving treatment against infection (HR = 0.48, 95%CI: 0.29-0.80).
CONCLUSION HCV treatment is evolving in patients with HCV-HIV co-infection. Ongoing drug use while in an OTP might negatively impact the readiness to treat infection.
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Affiliation(s)
- Arantza Sanvisens
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona 08916, Spain
| | - Inmaculada Rivas
- Mental Health and Addiction Service, Badalona Serveis Assistencials-BSA, Badalona 08911, Spain
| | - Eva Faure
- Mental Health and Addiction Service, Badalona Serveis Assistencials-BSA, Badalona 08911, Spain
| | - Néstor Espinach
- Mental Health and Addiction Service, Badalona Serveis Assistencials-BSA, Badalona 08911, Spain
| | - Anna Hernandez-Rubio
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona 08916, Spain
| | - Xavier Majó
- Program on HIV, STIs and Viral Hepatitis - PCAVIHV Public Health Agency of Catalonia, Generalitat de Catalunya, Barcelona 08005, Spain
| | - Joan Colom
- Program on HIV, STIs and Viral Hepatitis - PCAVIHV Public Health Agency of Catalonia, Generalitat de Catalunya, Barcelona 08005, Spain
| | - Robert Muga
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona 08916, Spain
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O'Keefe-Markman C, Lea KD, McCabe C, Hyshka E, Bubela T. Social values for health technology assessment in Canada: a scoping review of hepatitis C screening, diagnosis and treatment. BMC Public Health 2020; 20:89. [PMID: 31959155 PMCID: PMC6971980 DOI: 10.1186/s12889-020-8190-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 01/09/2020] [Indexed: 02/06/2023] Open
Abstract
Background Health care system decision makers face challenges in allocating resources for screening, diagnosis and treatment of hepatitis C. Approximately 240,000 individuals are infected with the hepatitis C virus (HCV) in Canada. Populations most affected by HCV include Indigenous people, people who inject drugs, immigrants and homeless or incarcerated populations as well as those born between 1946 and 1965. Curative but expensive drug regimens of novel direct acting antivirals (DAAs) are available. We aim to identify social values from academic literature for inclusion in health technology assessments. Methods We conducted a scoping review of academic literature to identify and analyze the social values and evidence-based recommendations for screening, diagnosis and treatment of HCV in Canada. After applying inclusion/exclusion criteria, we abstracted: type of intervention(s), population(s) affected, study location, screening methods, diagnostics and treatments. We then abstracted and applied qualitative codes for social values. We extracted social value statements and clustered them into one of 4 categories: (1) equity and justice, (2) duty to provide care, (3) maximization of population benefit, and (4) individual versus community interests. Results One hundred and eighteen articles met our inclusion criteria on screening, diagnosis and treatment of HCV in Canada. Of these, 54 (45.8%) discussed screening, 4 (3.4%) discussed diagnosis and 60 (50.8%) discussed treatment options. Most articles discussed the general population and other non-vulnerable populations. Articles that discussed vulnerable populations focused on people who inject drugs. We coded 1243 statements, most of which fell into the social value categories of equity and justice, duty to provide care and maximization of population benefit. Conclusion The academic literature identified an expanded set of social values to be taken into account by resource allocation decision makers in financially constrained environments. In the context of hepatitis C, authors called for greater consideration of equity and justice and the duty to provide care in making evidence-based recommendations for screening, diagnosis and treatment for different populations and in different settings that also account for individual and community interests.
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Affiliation(s)
| | - Kristina Dawn Lea
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Christopher McCabe
- Institute of Health Economics, Edmonton, AB, Canada.,Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Elaine Hyshka
- School of Public Health, University of Alberta, Edmonton, AB, Canada.,Inner City Health and Wellness, Royal Alexandra Hospital, Edmonton, AB, Canada
| | - Tania Bubela
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
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3
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Dodd Z, Banga CA, Mason K, Meaney C, Leszcz M, Sockalingam S. Engagement in Group Psychotherapy Among Marginalized Individuals With Hepatitis C. Int J Group Psychother 2016; 66:338-360. [PMID: 38449126 DOI: 10.1080/00207284.2016.1149410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
This article examines an innovative psychoeducational group model at a community-based hepatitis C treatment program in Toronto, Canada. Group support is increasingly used as part of community-based, interdisciplinary approaches to addressing the complex psychosocial needs and barriers to care of individuals living with and/or undergoing treatment for hepatitis C. This article articulates the theoretical framework and details of one such group model. It also examines group engagement and outcomes using data collected over three group cycles. Psychotherapeutic engagement was higher than might be anticipated for a highly marginalized population. Specifically, group cohesion measures were equivalent or higher compared to norms for other support/psychotherapy groups. This study suggests that individuals with complex psychosocial issues have the ability to engage meaningfully in group therapy.
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4
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Jordan AE, Des Jarlais DC, Arasteh K, McKnight C, Nash D, Perlman DC. Incidence and prevalence of hepatitis c virus infection among persons who inject drugs in New York City: 2006-2013. Drug Alcohol Depend 2015; 152:194-200. [PMID: 25891230 PMCID: PMC4458155 DOI: 10.1016/j.drugalcdep.2015.03.039] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 03/31/2015] [Accepted: 03/31/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Hepatitis C virus infection is a source of significant preventable morbidity and mortality among persons who inject drugs (PWID). We sought to assess trends in hepatitis C virus (HCV) infection among PWID from 2006 to 2013 in New York City (NYC). METHODS Annual cross-sectional surveys of PWID entering a large drug abuse treatment program were performed. Risk behavior questionnaires were administered, and HIV and HCV testing were conducted. Comparisons were made with prior prevalence and incidence estimates in 1990-1991 and 2000-2001 reflecting different periods of combined prevention and treatment efforts. RESULTS HCV prevalence among PWID (N: 1535) was 67% (95% CI: 66-70%) during the study period, and was not significantly different from that observed in 2000-2001. The estimated HCV incidence among new injectors (persons injecting for ≤6 years) during 2006-2013 was 19.5/100 PYO (95% CI: 17-23) and did not differ from that observed in 2000-2001 (18/100 PYO, 95% CI: 14-23/100). CONCLUSIONS Despite the expansion of combined prevention programming between 2000-2001 and 2006-2013, HCV prevalence remained high. Estimated HCV incidence among new injectors also remained high, and not significantly lower than in 2000-2001, indicating that expanded combined prevention efforts are needed to control the HCV epidemic among PWID in NYC.
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Affiliation(s)
- Ashly E. Jordan
- The Graduate Center at the City University of New York, 365 Fifth
Avenue, New York, New York 10016 USA,Center for Drug Use and HIV Research, New York, New York USA
| | - Don C. Des Jarlais
- Center for Drug Use and HIV Research, New York, New York USA,Mount Sinai Beth Israel, Baron Edmond de Rothschild Chemical
Dependency Institute, 120 Water St, Floor 24, New York, New York 10038 USA
| | - Kamyar Arasteh
- Center for Drug Use and HIV Research, New York, New York USA,Mount Sinai Beth Israel, Baron Edmond de Rothschild Chemical
Dependency Institute, 120 Water St, Floor 24, New York, New York 10038 USA
| | - Courtney McKnight
- Center for Drug Use and HIV Research, New York, New York USA,Mount Sinai Beth Israel, Baron Edmond de Rothschild Chemical
Dependency Institute, 120 Water St, Floor 24, New York, New York 10038 USA
| | - Denis Nash
- City University of New York, Hunter College, 2180 Third Avenue, New
York, New York 10035 USA
| | - David C. Perlman
- Center for Drug Use and HIV Research, New York, New York USA,Mount Sinai Beth Israel, 120 East 16 Street, New York,
NY 10003 USA
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5
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MacParland SA, Bilodeau M, Grebely J, Bruneau J, Cooper C, Klein M, Sagan SM, Choucha N, Balfour L, Bialystok F, Krajden M, Raven J, Roberts E, Russell R, Houghton M, Tyrrell DL, Feld JJ. The 3rd Canadian Symposium on Hepatitis C Virus: expanding care in the interferon-free era. Can J Gastroenterol Hepatol 2014; 28:481-7. [PMID: 25314353 PMCID: PMC4205903 DOI: 10.1155/2014/704919] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 08/12/2014] [Indexed: 01/26/2023] Open
Abstract
Hepatitis C virus (HCV) currently infects approximately 250,000 individuals in Canada and causes more years of life lost than any other infectious disease in the country. In August 2011, new therapies were approved by Health Canada that have achieved higher response rates among those treated, but are poorly tolerated. By 2014⁄2015, short-course, well-tolerated treatments with cure rates >95% will be available. However, treatment uptake is poor due to structural, financial, geographical, cultural and social barriers. As such, 'Barriers to access to HCV care in Canada' is a crucial topic that must be addressed to decrease HCV disease burden and potentially eliminate HCV in Canada. Understanding how to better care for HCV-infected individuals requires integration across multiple disciplines including researchers, clinical services and policy makers to address the major populations affected by HCV including people who inject drugs, baby boomers, immigrants and Aboriginal and⁄or First Nations people. In 2012, the National CIHR Research Training Program in Hepatitis C organized the 1st Canadian Symposium on Hepatitis C Virus (CSHCV) in Montreal, Quebec. The 2nd CSHCV was held in 2013 in Victoria, British Columbia. Both symposia were highly successful, attracting leading international faculty with excellent attendance leading to dialogue and knowledge translation among attendees of diverse backgrounds. The current article summarizes the 3rd CSHCV, held February 2014, in Toronto, Ontario.
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Affiliation(s)
| | - Marc Bilodeau
- Liver Unit, Department of Medicine, Université de Montréal, Montréal, Québec
| | - Jason Grebely
- The Kirby Institute, UNSW Australia, Sydney, Australia
| | - Julie Bruneau
- Department of Family Medicine, Université de Montréal, Montréal, Québec
| | - Curtis Cooper
- Division of Infectious Diseases, University of Ottawa, Ottawa, Ontario
| | | | - Selena M Sagan
- Department of Microbiology & Immunology, McGill University, Montreal, Quebec
| | - Norma Choucha
- Liver Unit, Department of Medicine, Université de Montréal, Montréal, Québec
| | - Louise Balfour
- Division of Infectious Diseases, University of Ottawa, Ottawa, Ontario
| | | | - Mel Krajden
- British Columbia Centre for Disease Control
- University of British Columbia, Vancouver, British Columbia
| | - Jennifer Raven
- Canadian Institutes of Health Research – Institute of Infection and Immunity, Ottawa, Ontario
| | | | - Rodney Russell
- Division of Biomedical Sciences, Memorial University of Newfoundland, St John’s, Newfoundland & Labrador
| | - Michael Houghton
- Li Ka Shing Institute of Virology, University of Alberta, Edmonton, Alberta
| | - D Lorne Tyrrell
- Li Ka Shing Institute of Virology, University of Alberta, Edmonton, Alberta
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6
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Al-Tayyib AA, Thiede H, Burt RD, Koester S. Unmet Health Care Needs and Hepatitis C Infection Among Persons Who Inject Drugs in Denver and Seattle, 2009. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2014; 16:330-40. [DOI: 10.1007/s11121-014-0500-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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7
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Grebely J, Dore GJ. Can hepatitis C virus infection be eradicated in people who inject drugs? Antiviral Res 2014; 104:62-72. [PMID: 24468275 DOI: 10.1016/j.antiviral.2014.01.002] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Revised: 01/07/2014] [Accepted: 01/11/2014] [Indexed: 12/23/2022]
Abstract
People who inject drugs (PWID) represent the core of the hepatitis C virus (HCV) epidemic in many countries and HCV-related disease burden continues to rise. There are compelling data demonstrating that with the appropriate programs, treatment for HCV infection among PWID is successful, with responses to therapy similar those observed in large randomized controlled trials in non-PWID. However, assessment and treatment for HCV infection lags far behind the numbers who could benefit from therapy, related to systems-, provider- and patient-related barriers to care. The approaching era of interferon-free directly acting antiviral therapy has the potential to provide one of the great advances in clinical medicine. Simple, tolerable and highly effective therapy will likely address many of these barriers, thereby enhancing the numbers of PWID cured of HCV infection. This commentary will consider why we should strive for the eradication of HCV infection among PWID, whether eradication of HCV infection among PWID is feasible, components that would be needed to achieve eradication of HCV infection in PWID, potential settings and strategies required to establish programs targeted towards eradicating HCV infection among PWID and the feasibility of eradication versus elimination of HCV infection among PWID. This article forms part of a symposium in Antiviral Research on "Hepatitis C: next steps toward global eradication."
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Affiliation(s)
- Jason Grebely
- The Kirby Institute, UNSW Australia, Sydney, Australia.
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8
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Jones L, Atkinson A, Bates G, McCoy E, Porcellato L, Beynon C, McVeigh J, Bellis MA. Views and experiences of hepatitis C testing and diagnosis among people who inject drugs: systematic review of qualitative research. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2013; 25:204-11. [PMID: 24332457 DOI: 10.1016/j.drugpo.2013.11.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 10/30/2013] [Accepted: 11/11/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Many developed countries are facing a major challenge to improve identification of individuals acutely and chronically infected with hepatitis C virus (HCV) infection. We explored the views and experiences of people who inject drugs (PWID) in relation to HCV testing, and diagnosis through a review and synthesis of qualitative research. METHODS Based on the thematic synthesis of qualitative research. Searches were conducted in 14 databases and supplemented by reference checking, hand searching of selected journals, and searches of relevant websites. Studies of any qualitative design that examined the views and experiences of, and attitudes towards, HCV testing and diagnosis among PWID or practitioners involved in their care were included. Key themes and sub-themes were systematically coded according to the meaning and content of the findings of each study which proceeded to the preparation of a narrative account of the synthesis. RESULTS 28 qualitative studies were identified. We identified a number of overarching descriptive themes in the literature, finding overall that PWID hold complex and differing views and experiences of testing and diagnosis. Three major themes emerged: missed opportunities for the provision of information and knowledge; shifting priorities between HCV testing and other needs; and testing as unexpected and routine. Evidence of missed opportunities for the provision of knowledge and information about HCV were clear, contributing to delays in seeking testing and providing a context to poor experiences of diagnosis. Influenced by the nature of their personal circumstances, perceptions of the risk associated with HCV and the prioritisation of other needs acted both to encourage and discourage the uptake of HCV testing. Undergoing HCV testing as part of routine health assessment, and an unawareness of being testing was common. An unexpected positive diagnosis exacerbated anxiety and confusion. CONCLUSION This review has identified that there are modifiable factors that affect the uptake of HCV testing and experiences of HCV diagnosis among PWID. Intervention development should focus on addressing these factors. There is a need for further research that engages PWID from a diverse range of populations to identify interventions, strategies and approaches that they consider valuable.
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Affiliation(s)
- L Jones
- Centre for Public Health, Faculty of Education, Health and Community, Liverpool John Moores University, 15-21 Webster Street, Liverpool L3 2ET, UK.
| | - A Atkinson
- Centre for Public Health, Faculty of Education, Health and Community, Liverpool John Moores University, 15-21 Webster Street, Liverpool L3 2ET, UK
| | - G Bates
- Centre for Public Health, Faculty of Education, Health and Community, Liverpool John Moores University, 15-21 Webster Street, Liverpool L3 2ET, UK
| | - E McCoy
- Centre for Public Health, Faculty of Education, Health and Community, Liverpool John Moores University, 15-21 Webster Street, Liverpool L3 2ET, UK
| | - L Porcellato
- Centre for Public Health, Faculty of Education, Health and Community, Liverpool John Moores University, 15-21 Webster Street, Liverpool L3 2ET, UK
| | - C Beynon
- Centre for Public Health, Faculty of Education, Health and Community, Liverpool John Moores University, 15-21 Webster Street, Liverpool L3 2ET, UK
| | - J McVeigh
- Centre for Public Health, Faculty of Education, Health and Community, Liverpool John Moores University, 15-21 Webster Street, Liverpool L3 2ET, UK
| | - M A Bellis
- Public Health Wales, Haydn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK
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Newman AI, Beckstead S, Beking D, Finch S, Knorr T, Lynch C, MacKenzie M, Mayer D, Melles B, Shore R. Treatment of chronic hepatitis C infection among current and former injection drug users within a multidisciplinary treatment model at a community health centre. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2013; 27:217-23. [PMID: 23616960 PMCID: PMC3742479 DOI: 10.1155/2013/515636] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Accepted: 09/08/2012] [Indexed: 01/04/2023]
Abstract
The aim of the present prospective observational study was to assess uptake and success of hepatitis C virus (HCV) treatment among a group of former and current injection drug users with chronic HCV infection at the Street Health Centre in Kingston, Ontario. The Street Health Centre offers hepatitis C education, assessment and treatment within a multidisciplinary, integrated and collaborative treatment model of care delivered by primary care professionals. The study enrolled a convenience sample of 34 patients. Seventy per cent of study patients had no postsecondary education, 85% were unemployed and one-third were unstably housed. A majority of study patients self-reported mental health problems. Of the 14 patients who initiated antiviral treatment in the study period, eight (57%) achieved sustained virological response. Regardless of virological outcome, patients who initiated treatment showed positive trends toward increased social and psychiatric stability, and decreases in high-risk behaviours. These results suggest that not only is successful treatment of chronic HCV infection in current and former injection drug users with concurrent psychiatric disorders possible, but the benefits of such treatment delivered in a community-based, multidisciplinary, primary care model may extend beyond narrowly defined virological outcomes.
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Affiliation(s)
- Adam Isaiah Newman
- Street Health Centre, Kingston Community Health Centres, Queen's University, Kingston, Ontario.
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Doyle JS, Aspinall E, Liew D, Thompson AJ, Hellard ME. Current and emerging antiviral treatments for hepatitis C infection. Br J Clin Pharmacol 2013; 75:931-43. [PMID: 22882367 PMCID: PMC3612710 DOI: 10.1111/j.1365-2125.2012.04419.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 08/07/2012] [Indexed: 12/21/2022] Open
Abstract
Newly licensed direct acting antivirals for hepatitis C virus HCV are able to cure up to 75% of patients chronically infected with genotype-1 infection, which is the predominant HCV strain in Europe and North America. Emerging antiviral therapies promise further increases in virological response, as well as improved tolerability, reduced duration of therapy, and will potentially eliminate the need for interferon use. This review highlights the main therapeutic agents used in current standard of care, including telaprevir and boceprevir. It goes on to evaluate the mechanisms of emerging drugs, their stage of development and response rates seen in research to date. Finally, it projects into the not too distant future to consider treatment strategies involving combinations of agents and interferon-free therapies, and in which patients they might prove most successful.
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Affiliation(s)
- Joseph S Doyle
- Centre for Population Health, Burnet Institute, Melbourne, Victoria, Australia.
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11
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Feld JJ. Treatment indication and response to standard of care with peginterferon and ribavirin in acute and chronic HCV infection. Best Pract Res Clin Gastroenterol 2012. [PMID: 23199502 DOI: 10.1016/j.bpg.2012.09.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Great strides have been made in the treatment of hepatitis C virus (HCV) infection in the past decade. Although there is much focus on the development of new direct-acting antivirals (DAA), interferon and ribavirin remain the backbone of therapy for both acute and chronic HCV infections. While DAA therapy will likely eventually largely replace interferon, in much of the world and for genotype non-1 patients, peginterferon and ribavirin remain first-line therapy. Interferon-based therapy is highly effective in acute HCV with high response rates with short courses of therapy. Unfortunately once infection progresses to chronicity, treatment success rates drop off considerably. The indications, pre-treatment evaluation and efficacy of peginterferon and ribavirin therapy in the treatment of acute and chronic HCV infection are discussed with strategies to improve outcomes and manage adverse events.
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Affiliation(s)
- Jordan J Feld
- Toronto Western Hospital Liver Centre, Sandra Rotman Centre for Global Health, University of Toronto, Toronto, Canada.
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12
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Ward JW, Valdiserri RO, Koh HK. Hepatitis C Virus Prevention, Care, and Treatment: From Policy to Practice. Clin Infect Dis 2012; 55 Suppl 1:S58-63. [DOI: 10.1093/cid/cis392] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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13
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Positive health beliefs and behaviours in the midst of difficult lives: Women who inject drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2012; 23:312-8. [DOI: 10.1016/j.drugpo.2012.01.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Revised: 12/01/2011] [Accepted: 01/12/2012] [Indexed: 12/11/2022]
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14
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Grebely J, Pham ST, Matthews GV, Petoumenos K, Bull RA, Yeung B, Rawlinson W, Kaldor J, Lloyd A, Hellard M, Dore GJ, White PA. Hepatitis C virus reinfection and superinfection among treated and untreated participants with recent infection. Hepatology 2012; 55:1058-69. [PMID: 22031335 PMCID: PMC3310282 DOI: 10.1002/hep.24754] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2011] [Accepted: 10/03/2011] [Indexed: 02/06/2023]
Abstract
UNLABELLED The purpose of the study was to evaluate reinfection and superinfection during treatment for recent hepatitis C virus (HCV). The Australian Trial in Acute Hepatitis C (ATAHC) was a prospective study of the natural history and treatment of recent HCV. Reinfection and superinfection were defined by detection of infection with an HCV strain distinct from the primary strain (using reverse-transcription polymerase chain reaction [RT-PCR] and subtype-specific nested RT-PCR assays) in the setting of spontaneous or treatment-induced viral suppression (one HCV RNA <10 IU/mL) or persistence (HCV RNA >10 IU/mL from enrollment to week 12). Among 163 patients, 111 were treated, 79% (88 of 111) had treatment-induced viral suppression, and 60% (67 of 111) achieved sustained virological response. Following treatment-induced viral suppression, recurrence was observed in 19% (17 of 88), including 12 with relapse and five with reinfection (4.7 cases per 100 person-years [PY], 95% confidence interval [CI]: 1.9, 11.2). Among 52 untreated patients, 58% (30 of 52) had spontaneous viral suppression and recurrence was observed in 10% (3 of 30), including two with reinfection. Following reinfection, alanine aminotransferase (ALT) levels >1.5× the upper limit of normal were observed in 71% (5 of 7). Among 37 with persistence, superinfection was observed in 16% (3 of 19) of those treated and 17% (3 of 18) of those untreated. In adjusted analysis, reinfection/superinfection occurred more often in participants with poorer social functioning at enrollment and more often in those with ongoing injecting drug use (IDU). CONCLUSION Reinfection and superinfection can occur during treatment of recent HCV and are associated with poor social functioning and ongoing IDU. ALT levels may be a useful clinical marker of reexposure.
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Affiliation(s)
- Jason Grebely
- Kirby Institute for infection and immunity in society, University of New South Wales, Sydney, Australia.
| | - Son Truong Pham
- School of Biotechnology and Biomedical Sciences, University of New South Wales, Sydney, Australia
| | - Gail V. Matthews
- The Kirby Institute for infection and immunity in society, The University of New South Wales, Sydney, Australia
| | - Kathy Petoumenos
- The Kirby Institute for infection and immunity in society, The University of New South Wales, Sydney, Australia
| | - Rowena A. Bull
- School of Biotechnology and Biomedical Sciences, University of New South Wales, Sydney, Australia,Centre for Infection and Inflammation Research, School of Medical Sciences, The University of New South Wales, Sydney, Australia
| | - Barbara Yeung
- The Kirby Institute for infection and immunity in society, The University of New South Wales, Sydney, Australia
| | - William Rawlinson
- Virology Division, Southern Eastern Area Laboratory Services, Prince of Wales Hospital, Sydney, Australia
| | - John Kaldor
- The Kirby Institute for infection and immunity in society, The University of New South Wales, Sydney, Australia
| | - Andrew Lloyd
- Centre for Infection and Inflammation Research, School of Medical Sciences, The University of New South Wales, Sydney, Australia
| | | | - Gregory J. Dore
- The Kirby Institute for infection and immunity in society, The University of New South Wales, Sydney, Australia
| | - Peter A. White
- School of Biotechnology and Biomedical Sciences, University of New South Wales, Sydney, Australia
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Abstract
PURPOSE OF REVIEW Despite a high burden of hepatitis C virus (HCV) and HIV infection among IDUs and the advent of effective therapies, assessment and treatment remain limited. The current review focuses on the management of HCV and HIV among IDUs, focusing particularly on recent strategies to enhance assessment, uptake and response to HCV and HIV treatment. RECENT FINDINGS There are compelling data demonstrating that with the appropriate programs, treatment for HIV and HCV among IDUs is successful. However, assessment and treatment for HCV and HIV lags far behind the numbers of IDUs who could benefit from therapy, related to systems, provider and patient-related barriers to care. Strategies for enhancing assessment and treatment for HCV and HIV have been developed, including novel models integrating HCV/HIV care within existing community-based and drug and alcohol clinics, innovative methods for education delivery (including peer-support models) and directly observed therapy. SUMMARY As we move forward, research must move beyond demonstrating that HCV and HIV infections can be successfully treated among IDUs. There is clear evidence that this is both feasible and effective. Novel strategies to enhance assessment, uptake and response to treatment should be evaluated among IDUs to elucidate mechanisms to enhance care for this underserved population.
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Grebely J, Matthews GV, Hellard M, Shaw D, van Beek I, Petoumenos K, Alavi M, Yeung B, Haber PS, Lloyd AR, Kaldor JM, Dore GJ. Adherence to treatment for recently acquired hepatitis C virus (HCV) infection among injecting drug users. J Hepatol 2011; 55:76-85. [PMID: 21145855 PMCID: PMC3117933 DOI: 10.1016/j.jhep.2010.10.033] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Revised: 09/27/2010] [Accepted: 10/18/2010] [Indexed: 01/08/2023]
Abstract
BACKGROUND & AIMS Adherence to HCV therapy impacts sustained virological response (SVR) but there are limited data on adherence, particularly among injecting drug users (IDUs). We assessed 80/80 adherence (≥80% of PEG-IFN doses, ≥80% treatment), on-treatment adherence, and treatment completion in a study of treatment of recent HCV infection (ATAHC). METHODS Participants with HCV received pegylated interferon (PEG-IFN) alfa-2a (180μg/week, n=74) and those with HCV/HIV received PEG-IFN alfa-2a with ribavirin (n=35), for a planned 24 weeks. Logistic regression analyses were used to identify predictors of PEG-IFN 80/80 adherence. RESULTS A total of 109 out of 163 patients received treatment (HCV, n=74; HCV/HIV, n=35), with 75% ever reporting IDU. The proportion with 80/80 PEG-IFN adherence was 82% (n=89). During treatment, 14% missed ≥1 dose (on-treatment adherence=99%). Completion of 0-4, 5-19, 20-23, and all 24 weeks of PEG-IFN therapy occurred in 10% (n=11), 14% (n=15), 6% (n=7) and 70% (n=76) of cases, respectively. Participants with no tertiary education were less likely to have 80/80 PEG-IFN adherence (AOR 0.29, p=0.045). IDU prior to or during treatment did not impact 80/80 PEG-IFN adherence. SVR was higher among those patients with ≥80/80 PEG-IFN adherence (67% vs. 35%, p=0.007), but similar among those with and without missed doses during therapy (73% vs. 60%, p=0.309). SVR in those patients discontinuing therapy between 0-4, 5-19, 20-23, and 24 weeks was 9%, 33%, 43%, and 76%, respectively (p<0.001). CONCLUSIONS High adherence to treatment for recent HCV was observed, irrespective of IDU prior to, or during, therapy. Sub-optimal PEG-IFN exposure was mainly driven by early treatment discontinuation rather than missed doses during therapy.
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Affiliation(s)
- Jason Grebely
- National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia.
| | - Gail V. Matthews
- National Centre in HIV Epidemiology and Clinical Research, University of New South Wales (UNSW), Sydney,HIV/Immunology/Infectious Diseases Clinical Services Unit, St Vincent's Hospital, Sydney
| | - Margaret Hellard
- Burnet Institute, Melbourne,Infectious Diseases Unit, The Alfred Hospital, Melbourne
| | - David Shaw
- Department of Medicine, Royal Adelaide Hospital, Adelaide
| | | | - Kathy Petoumenos
- National Centre in HIV Epidemiology and Clinical Research, University of New South Wales (UNSW), Sydney
| | - Maryam Alavi
- National Centre in HIV Epidemiology and Clinical Research, University of New South Wales (UNSW), Sydney
| | - Barbara Yeung
- National Centre in HIV Epidemiology and Clinical Research, University of New South Wales (UNSW), Sydney
| | - Paul S. Haber
- National Centre in HIV Epidemiology and Clinical Research, University of New South Wales (UNSW), Sydney
| | - Andrew R. Lloyd
- Inflammation and Infection Research Centre, School of Medical Sciences, UNSW, Sydney
| | - John M. Kaldor
- National Centre in HIV Epidemiology and Clinical Research, University of New South Wales (UNSW), Sydney
| | - Gregory J. Dore
- National Centre in HIV Epidemiology and Clinical Research, University of New South Wales (UNSW), Sydney,HIV/Immunology/Infectious Diseases Clinical Services Unit, St Vincent's Hospital, Sydney
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Abstract
In developed nations, the majority of new HCV infections are acquired by injection drug users. Acute HCV infection is generally asymptomatic and is followed by spontaneous viral clearance in approximately 25% of individuals. However, given the asymptomatic nature of infection and difficulties in identifying and following those at risk of acquiring infection, our knowledge of treatment for acute HCV infection has been hampered. Much of what is known about the timing, optimal regimen and duration of therapy comes from small, prospective, observational studies and randomized, controlled trials in selected populations. Furthermore, data on the treatment of acute HCV infection among injection drug users and patients co-infected with HCV and HIV are limited. Genetic testing for variations in IL28B may provide an additional diagnostic tool for the optimal management and treatment of acute HCV infection. This Review highlights current knowledge of the epidemiology, diagnosis, natural history and treatment of acute HCV infection, including proposed recommendations for the assessment and treatment of this infection.
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Affiliation(s)
- Jason Grebely
- Viral Hepatitis Clinical Research Program, National Center in HIV Epidemiology and Clinical Research, University of New South Wales, Corner Boundary and West Streets, Darlinghurst, Sydney, NSW 2010, Australia.
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Grebely J, Dore GJ. Prevention of hepatitis C virus in injecting drug users: a narrow window of opportunity. J Infect Dis 2011; 203:571-4. [PMID: 21282190 DOI: 10.1093/infdis/jiq111] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Grebely J, Knight E, Ngai T, Genoway KA, Raffa JD, Storms M, Gallagher L, Krajden M, Dore GJ, Duncan F, Conway B. Reinfection with hepatitis C virus following sustained virological response in injection drug users. J Gastroenterol Hepatol 2010; 25:1281-4. [PMID: 20594256 DOI: 10.1111/j.1440-1746.2010.06238.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIM Despite that 60-90% of injection drug users (IDUs) are infected with hepatitis C virus (HCV) infection, IDUs are often denied therapy based on concerns of reinfection following treatment. However, there are little data in this regard. We evaluated HCV re-infection following sustained virologic response (SVR) among HCV-infected IDUs having received HCV treatment in a multidisciplinary program. METHODS Following treatment, participants were encouraged to return at follow-up intervals of 1 year and illicit drug use histories were obtained. In those with SVR, HCV RNA testing by PCR was performed to determine if relapse or reinfection occurred. RESULTS Among 58 receiving HCV treatment between January 2002 and December 2006, 60% (35 of 58) achieved an SVR. Patients were followed for a median of 2.0 years following SVR (range, 0.4-5.0 years), with ongoing illicit and injection drug use reported in 54% (19 of 35) and 46% (16 of 35). Of the 35 with SVR, 28 remained HCV RNA negative during follow-up (80%), with four lost to follow-up and one dying of hepatocellular carcinoma and two cases of reinfection were observed (2 of 35). The rates of reinfection were 3.2 per 100 p-y (95% CI:0.4, 11.5) overall and 5.3 per 100 p-y (95% CI:0.6, 19.0) among those reporting injecting following SVR (n = 16). One of two participants with HCV re-infection spontaneously cleared virus following reinfection. CONCLUSION The rate of reinfection following treatment for HCV infection among current and former IDUs engaged in a multidisciplinary program is low.
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Affiliation(s)
- Jason Grebely
- National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Darlinghurst, New South Wales, Australia.
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Clinical Management of Drug Addicts Infected with Human Immunodeficiency Virus and Hepatitis C Virus. J Addict Dis 2008; 27:1-10. [DOI: 10.1300/j069v27n02_01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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