Observational Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 14, 2020; 26(38): 5874-5883
Published online Oct 14, 2020. doi: 10.3748/wjg.v26.i38.5874
Monitoring hepatitis C virus treatment rates in an Opioid Treatment Program: A longitudinal study
Arantza Sanvisens, Inmaculada Rivas, Eva Faure, Néstor Espinach, Anna Hernandez-Rubio, Xavier Majó, Joan Colom, Robert Muga
Arantza Sanvisens, Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona 08916, Spain
Inmaculada Rivas, Eva Faure, Néstor Espinach, Mental Health and Addiction Service, Badalona Serveis Assistencials-BSA, Badalona 08911, Spain
Anna Hernandez-Rubio, Robert Muga, Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona 08916, Spain
Xavier Majó, Joan Colom, Program on HIV, STIs and Viral Hepatitis - PCAVIHV Public Health Agency of Catalonia, Generalitat de Catalunya, Barcelona 08005, Spain
Author contributions: Sanvisens A and Muga R designed the study and wrote the first draft of the manuscript; Sanvisens A managed the literature searches and statistical analysis; Rivas I, Faure E, Espinach N, and Hernandez-Rubio A recruited the study population and took care of patients; Sanvisens A, Rivas I, Majó X, Colom J and Muga R reviewed the literature and made contributions to the interpretation of data; and all the authors contributed to the discussion section and revised and approved the final manuscript.
Supported by the Ministry of Science, Innovation and Universities, Carlos III Health Institute (ISCIII), European Fund for Regional Development (FEDER), Network for Cooperative Research in Health (RETICS), Spain (No. RD16/0017/0003, PI17/00174, INT19/00026, CD19/00019); the Ministry of Health, National Plan on Drugs (PNSD), Spain (No. 2018/020); the European Commission (806996-JUSTSO-JUST2017-AG-DRUG); the Gilead Fellowship Program, Gilead Sciences (No. GLD17/187); the Ministry of Education, Spain (No. PRX18/00245); the Agency for Management of University and Research Grants, Government of Catalonia (No. 2017SGR316); and the Municipal Institute of Personal Services-IMSP, Badalona.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of the Hospital Universitari Germans Trias i Pujol (PI-15-100), Badalona, Spain.
Informed consent statement: All study participants, or their legal guardian, provided written consent prior to study enrollment.
Conflict-of-interest statement: The authors of this manuscript having no conflicts of interest to disclose.
Data sharing statement: There is no additional data available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Robert Muga, MD, PhD, Professor, Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Ctra. canyet s/n, Badalona 08916, Spain. rmuga.germanstrias@gencat.cat
Received: June 9, 2020
Peer-review started: June 9, 2020
First decision: July 29, 2020
Revised: August 12, 2020
Accepted: September 17, 2020
Article in press: September 17, 2020
Published online: October 14, 2020
Processing time: 127 Days and 1.5 Hours
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.

Keywords: Direct-acting antiviral agents; Opioid Treatment Program; Opioid agonist therapy; Hepatitis C virus infection; Human immunodeficiency virus infection; Drug use

Core Tip: Longitudinal study carried out in the only Opioid Treatment Program authorized for the provision of methadone or buprenorphine in a large urban area of 360000 inhabitants. Results indicate that hepatitis C virus treatment rates are increasing since the introduction of direct antiviral agents and identifies gaps and challenges on the readiness to treat infection.