Grebely, Jason, Alavi, Maryam, Micallef, Michelle, Dunlop, Adrian J., Balcomb, Anne C., Phung, Nghi, Weltman, Martin D., Day, Carolyn A., Treloar, Carla, Bath, Nicky, Haber, Paul S., and Dore, Gregory J. (2016) Treatment for hepatitis C virus infection among people who inject drugs attending opioid substitution treatment and community health clinics: The ETHOS Study. Addiction, 111 (2). pp. 311-319.

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Abstract

Aims: To estimate adherence and response to therapy for chronic hepatitis C virus (HCV) infection among people with a history of injecting drug use. A secondary aim was to identify predictors of HCV treatment response. Design: Prospective cohort recruited between 2009 and 2012. Participants were treated with peg-interferon alfa-2a/ribavirin for 24 (genotypes 2/3, G2/3) or 48weeks (genotype 1, G1).

Setting: Six opioid substitution treatment (OST) clinics, two community health centres and one Aboriginal community-controlled health organization providing drug treatment services in New South Wales, Australia.

Participants: Among 415 people with a history of injecting drug use and chronic HCV assessed by a nurse, 101 were assessed for treatment outcomes (21% female).

Measurements: Study outcomes were treatment adherence and sustained virological response (SVR, undetectable HCV RNA >24weeks post-treatment). Findings: Among 101 treated, 37% (n=37) had recently injected drugs (past 6months) and 62% (n=63) were receiving OST. Adherence ≥80% was 86% (n=87). SVR was 74% (75 of 101), with no difference observed by sex (males: 76%, females: 67%, P=0.662). In adjusted analysis, age <35 (versus ≥45years) [adjusted odds ratio (aOR)=5.06, 95% confidence interval (CI)=1.47, 17.40] and on-treatment adherence ≥80% independently predicted SVR (aOR=19.41, 95% CI=3.61, 104.26]. Recent injecting drug use at baseline was not associated with SVR.

Conclusions: People with a history of injecting drug use and chronic hepatitis C virus attending opioid substitution treatment and community health clinics can achieve adherence and responses to interferon-based therapy similar to other populations, despite injecting drugs at baseline. Younger age and adherence are predictive of improved response to hepatitis C virus therapy.

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