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ARTICLE

Treatment as Prevention: A Comprehensive Approach to Hepatitis C Virus in Persons Who Inject Drugs

AUG 09, 2017 | AMANDA BINKLEY, PHARMD, AAHIVP
In the second study, Stein et al evaluated the effects of behavioral interventions on 89 patients who were randomized to receive motivational interviewing or to an equal attention control group. Both arms received 4 sessions of either motivational interviewing or equal attention meetings. The overall cumulative incidence of HCV seroconversion in the motivational interviewing group was 18% (95% CI, 5.9%-30%) compared with 14% (95% CI, 4.3%-23.6%) in the control arm.7

Further, 5 studies have been published to date examining the effects of substance abuse treatment programs that do not specify the treatment modalities. Two of the 5 studies demonstrated a decreased incidence rate in those who were enrolled in the treatment programs, with calcu­lated incidence rates of 0.84 and 0.69.2 The other 3 studies demonstrated a higher incidence of HCV infection with published relative risks (RR) of 6.25 (95% CI, 1.3-30.9), 1.86 (95% CI, 1.20-2.35) in the first 2, and a hazard ratio (HR) of 1.02 (95% CI, 0.48-2.02) in the third.2 When the studies examining the effects of substance use treatment pro­grams were combined, the overall RR was 1.43 (95% CI, 0.79-2.58).2

An additional 8 observational studies were conducted looking at the effects of opiate replacement therapy pro­grams on the rate of HCV seroconversion. Six of these 8 trials observed a lower HCV seroconversion rate in per­sons who were enrolled in the opiate replacement ther­apy, including both continuous and interrupted, com­pared with those who were not enrolled.2 There was an increased rate of HCV seroconversion observed in the evaluation conducted by Crofts et al among the patients receiving continuous opiate replacement therapy com­pared with those receiving no opiate replacement ther­apy; however, the incidence of HCV seroconversion was lower in patients receiving intermittent opiate replace­ment therapy. The overall pooled RR for HCV seroconversion in those receiving any form of opiate replacement therapy was .60 (95% CI, 0.35-1.03). When comparing the patients enrolled in continuous opiate replacement therapy with those who had intermittent adherence or left opiate replacement therapy, the RR increased to .70 (95% CI, 0.14-3.60).2

Most recently, The British Columbia Hepatitis Testers cohort presented an abstract at the American Associa­tion for the Study of Liver Diseases (AASLD) conference in 2016 detailing the incidence of HCV reinfection in approximately 17,000 patients undergoing opiate sub­stitution therapy (OST). The results demonstrate that PWID are more likely to become reinfected if they spon­taneously clear the infection versus those who achieve a sustained virologic response (SVR): 1.88/100 person year versus 1.14/100 person year, respectively.8 The fac­tors that were identified to be statistically significantly associated with a lower HR included ≥1 mental health counseling visit and OST.8

Seven studies were conducted evaluating the effects of syringe exchange programs (SEPs) in North America. The results of 5 of the studies demonstrated no significant difference in the rate of HCV seroconversion. A study by Patrick et al evaluated Canadian patients who attended an SEP more than once per week. The results indicated an HCV seroconversion rate of 54.7% in those participating in a SEP compared with 26.3% for those who did not.2 In contrast, a case control evaluation was conducted by Hagan et al in 1995 evaluating the use of any SEP during the study period. They demonstrated a statistically significant lower rate of HCV seroconversion in those participating in an SEP compared with those who did not. Overall, the pooled RR for the 7 studies was 1.62 (95% CI, 1.04-2.52).2


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