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Midgard H, Hajarizadeh B, Cunningham EB, Conway B, Backmund M, Bruggmann P, Bruneau J, Bourgeois S, Dunlop A, Foster GR, Hellard M, Robaeys G, Thurnheer MC, Weltman M, Amin J, Marks PS, Quiene S, Dore GJ, Dalgard O, Grebely J. Changes in risk behaviours during and following treatment for hepatitis C virus infection among people who inject drugs: The ACTIVATE study. Int J Drug Policy 2017. [PMID: 28633998 DOI: 10.1016/j.drugpo.2017.05.040] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND The risk of hepatitis C virus (HCV) reinfection due to continued injecting risk behaviours might remain a barrier to HCV treatment among people who inject drugs. We aimed to evaluate changes in risk behaviours during and following HCV treatment among people with ongoing injecting drug use or receiving opioid substitution treatment (OST). METHODS ACTIVATE was an international multicentre clinical trial conducted between 2012 and 2014. Participants with HCV genotypes 2/3 infection were treated with peg-interferon/ribavirin for 12 or 24 weeks and completed a self-administered behavioural questionnaire at each study visit. The impact of time in treatment and follow-up on longitudinally measured recent (past month) behavioural outcomes was evaluated using generalized estimating equations. RESULTS Among 93 enrolled participants (83% male, median age 41 years), 55 (59%) had injected in the past month. Any injecting drug use decreased during HCV treatment and follow-up (OR 0.89 per incremental study visit; 95% CI 0.83-0.95). No significant changes were found in ≥daily injecting (OR 0.98; 95% CI 0.89-1.07), use of non-sterile needles (OR 0.94; 95% CI 0.79-1.12), sharing of injecting paraphernalia (OR 0.87; 95% CI 0.70-1.07) or non-injecting drug use (OR 1.01; 95% CI 0.92-1.10). Hazardous alcohol use decreased throughout (OR 0.56; 95% CI 0.40-0.77) and OST increased between enrolment and end of treatment (OR 1.48; 95% CI 1.07-2.04). CONCLUSIONS Recent injecting drug use and hazardous alcohol use decreased, while OST increased during and following HCV treatment among participants with ongoing injecting drug use. These findings support further expansion of HCV care among PWID.
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Affiliation(s)
- Håvard Midgard
- Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Norway; The Kirby Institute, UNSW Sydney, Australia; Department of Gastroenterology, Oslo University Hospital, Oslo, Norway.
| | | | | | - Brian Conway
- Vancouver Infectious Diseases Center, Vancouver, Canada
| | | | | | - Julie Bruneau
- CHUM Research Center, Université de Montréal, Montreal, Canada
| | | | - Adrian Dunlop
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Graham R Foster
- The Liver Unit, Queen Mary University of London, London, United Kingdom
| | | | - Geert Robaeys
- Department of Gastroenterology and Hepatology, Ziekenhuis Oost Limburg, Genk, Belgium; Department of Hepatology, UZ Leuven, Leuven, Belgium; Faculty of Medicine and Life Sciences, Limburg Clinical Research Program, Hasselt University, Hasselt, Belgium
| | - Maria C Thurnheer
- Division of Infectious Diseases, University Hospital and University of Bern, Bern, Switzerland
| | | | - Janaki Amin
- The Kirby Institute, UNSW Sydney, Australia; Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | | | | | | | - Olav Dalgard
- Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Norway
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Cunningham EB, Hajarizadeh B, Dalgard O, Amin J, Hellard M, Foster GR, Bruggmann P, Conway B, Backmund M, Robaeys G, Swan T, Marks PS, Quiene S, Applegate TL, Weltman M, Shaw D, Dunlop A, Bruneau J, Midgard H, Bourgeois S, Thurnheer MC, Dore GJ, Grebely J. Adherence to response-guided pegylated interferon and ribavirin for people who inject drugs with hepatitis C virus genotype 2/3 infection: the ACTIVATE study. BMC Infect Dis 2017; 17:420. [PMID: 28610605 PMCID: PMC5470219 DOI: 10.1186/s12879-017-2517-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 06/01/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The 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. METHODS ACTIVATE 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). RESULTS Among 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). CONCLUSIONS This 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, 2011.
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Affiliation(s)
| | | | | | - Janaki Amin
- The Kirby Institute, UNSW Sydney, Sydney, NSW Australia
| | | | | | | | - Brian Conway
- Vancouver Infectious Diseases Center, Vancouver, BC Canada
| | | | - Geert Robaeys
- Department of Gastroenterology and Hepatology, Ziekenhuis Oost Limburg, Genk, Belgium
- Department of Hepatology, UZ Leuven, Leuven, Belgium
- UHasselt, Hasselt, Belgium
| | - Tracy Swan
- Treatment Action Group, New York, NY USA
| | | | - Sophie Quiene
- The Kirby Institute, UNSW Sydney, Sydney, NSW Australia
| | | | | | - David Shaw
- Royal Adelaide Hospital, Adelaide, South Australia Australia
| | - Adrian Dunlop
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW Australia
| | - Julie Bruneau
- Research Center, Centre Hospitalier de l’Universite de Montreal (CRCHUM), Montreal, Quebec, Canada
| | | | | | | | | | - Jason Grebely
- The Kirby Institute, UNSW Sydney, Sydney, NSW Australia
| | - on behalf of the ACTIVATE Study Group
- The Kirby Institute, UNSW Sydney, Sydney, NSW Australia
- Akershus University Hospital, Oslo, Norway
- The Liver Unit, Queen Mary University of London, London, UK
- Arud Centres for Addiction Medicine, Zurich, Switzerland
- Vancouver Infectious Diseases Center, Vancouver, BC Canada
- Ludwig Maximilians-University Munich, Munich, Germany
- Department of Gastroenterology and Hepatology, Ziekenhuis Oost Limburg, Genk, Belgium
- Department of Hepatology, UZ Leuven, Leuven, Belgium
- UHasselt, Hasselt, Belgium
- Treatment Action Group, New York, NY USA
- Nepean Hospital, Sydney, NSW Australia
- Royal Adelaide Hospital, Adelaide, South Australia Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW Australia
- Burnet Institute, Melbourne, VIC Australia
- Research Center, Centre Hospitalier de l’Universite de Montreal (CRCHUM), Montreal, Quebec, Canada
- Stuivenberg ZNA, Antwerp, Belgium
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
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Crawford DHG, Dore GJ, Sievert W, Cheng WSC, Weltman M, McCaughan G, Rawlinson W, Marks PS, Yoshihara M, Rizkalla B, Roberts SK. Early on-treatment viral load and baseline METAVIR score: improved prediction of sustained virological response in HCV genotype 1 patients. Antivir Ther 2012; 17:849-54. [DOI: 10.3851/imp2104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2011] [Indexed: 10/28/2022]
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Cheng WSC, Roberts SK, McCaughan G, Sievert W, Weltman M, Crawford D, Rawlinson W, Marks PS, Thommes J, Rizkalla B, Yoshihara M, Dore GJ. Low virological response and high relapse rates in hepatitis C genotype 1 patients with advanced fibrosis despite adequate therapeutic dosing. J Hepatol 2010; 53:616-23. [PMID: 20619475 DOI: 10.1016/j.jhep.2010.04.024] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2009] [Revised: 03/19/2010] [Accepted: 04/11/2010] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS The impact of fibrosis stage on chronic hepatitis C virus (HCV) treatment response was explored in CHARIOT, a study of high dose peginterferon alfa-2a (PEG-IFNalpha-2a) induction therapy in treatment naïve genotype 1 infection. METHODS Eight hundred and ninety-six patients were randomised 1:1 to 360 microg (n=448) or 180 microg (n=448) PEG-IFNalpha-2a weekly with RBV 1000-1200 mg/day for 12 weeks followed by 36 weeks of 180 microg PEG-IFNalpha-2a weekly plus RBV 1000-1200 mg/day. Virological responses were assessed at week 4, 8, 12, 24, 48 (end of therapy), and 24 weeks following therapy (sustained virological response, SVR). As previously reported, there was no significant difference in SVR in the induction (53%) and standard (50%) arms, therefore the pooled study population was used for analysis of SVR and relapse. RESULTS A marked step-wise decline in SVR was evident by fibrosis stage: F0 (70%); F1 (60%); F2 (51%); F3 (31%); F4 (10%) (p<0.0001). Early virological responses were lower among F3/4 patients, including rapid virological response (RVR) (21% vs. 34% for F3/4 and F0-2, respectively) (p=0.0072), and the RVR positive predictive value was also lower (63% vs. 80%). Virological relapse rates were similar in early disease stages (F0, 16%; F1, 23%; F2, 26%), but increased markedly in advanced fibrosis (F3, 50%; F4, 80%) (p<0.0001). Cumulative PEG-IFNalpha-2a and ribavirin doses were similar among patients with F3/4 and F0-2 within treatment arms through week 4, 8, 12, and week 24. CONCLUSIONS Low virological response in hepatitis C genotype 1 patients with advanced fibrosis is not explained by inadequate cumulative PEG-IFN and ribavirin doses.
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