Successful treatment of chronic hepatitis C with triple therapy in an opioid agonist treatment program

Litwin, Alain H.; Soloway, Irene; Cockerham-Colas, Lauren; Reynoso, Sheila; Heo, Moonseong; Tenore, Christopher; Roose, Robert J.

doi:10.1016/j.drugpo.2015.08.008

Cited by 20 publications

(21 citation statements)

References 29 publications

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“…Strategies may include early referral to HCV care once a patient initiates opioid drug treatment or co-locating treatment for substance use disorders with care for HCV infection. The implications of our findings are consistent with other studies conducted in methadone programs, in which HCV care was integrated into those settings and, even in the era of interferon, PWUDs were able to be successfully linked to HCV care, initiate treatment, and even achieve HCV cure (Bonkovsky et al, 2008; Litwin et al, 2009; Litwin et al, 2015; Stein et al, 2012). Additionally, co-location of HIV and buprenorphine treatment has also been associated with improved outcomes for both HIV and opioid use (Altice et al, 2011; Fiellin et al, 2011).…”

Section: Discussionsupporting

confidence: 89%

Retention in buprenorphine treatment is associated with improved HCV care outcomes

Norton

Beitin

Glenn

et al. 2017

Journal of Substance Abuse Treatment

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Persons who inject drugs, most of whom are opioid dependent, comprise the majority of the HCV infected in the United States. As the national opioid epidemic unfolds, increasing numbers of people are entering the medical system to access treatment for opioid use disorder, specifically with buprenorphine. Yet little is known about HCV care in patients accessing buprenorphine-based opioid treatment. We sought to determine the HCV prevalence, cascade of care, and the association between patient characteristics and completion of HCV cascade of care milestones for patients initiating buprenorphine treatment. We reviewed electronic health records of all patients who initiated buprenorphine treatment at a primary-care clinic in the Bronx, NY between January 2009-January 2014. Of the 390 patients who initiated buprenorphine treatment, 123 were confirmed to have chronic HCV infection. The only patient characteristic associated with achieving HCV care milestones was retention in opioid treatment. Patients retained (vs. not retained) in buprenorphine treatment were more likely to be referred for HCV specialty care (63.1% vs. 34.0%, p<0.01), achieve an HCV-specific evaluation (40.8% vs. 21.3%, p<0.05), be offered HCV treatment (22.4% vs. 8.5%, p<0.05), and initiate HCV treatment (9.2% vs. 6.4%, p=0.6). Given the current opioid epidemic in the US and the growing number of people receiving buprenorphine treatment, there is an unprecedented opportunity to access and treat persons with HCV, reducing HCV transmission, morbidity and mortality. Retention in opioid treatment may improve linkage and retention in HCV care; innovative models of care that integrate opioid drug treatment with HCV treatment are essential.

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Section: Discussionsupporting

confidence: 89%

Retention in buprenorphine treatment is associated with improved HCV care outcomes

Norton

Beitin

Glenn

et al. 2017

Journal of Substance Abuse Treatment

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“…In PWID, treatment of chronic HCV is safe and effective (Alvarez-Uria et al, 2009; Backmund et al, 2001; Bruggmann et al, 2008; Dalgard, 2005; Dimova et al, 2013; Dore et al, 2010; Grebely, Genoway, et al, 2007; Grebely et al, 2010; Grebely, Raffa, et al, 2007; Guadagnino et al, 2007; Hellard et al, 2009; Jack et al, 2009; Jafferbhoy et al, 2012; Jeffrey et al, 2007; Lindenburg et al, 2011; Manolakopoulos et al, 2010; Martinez et al, 2010; Matthews et al, 2005; Mauss et al, 2004; Melin et al, 2010; Neri et al, 2002; Papadopoulos et al, 2010; Robaeys et al, 2006; Sasadeusz et al, 2011; Schaefer et al, 2003, 2007; Sylvestre, 2002; Sylvestre et al, 2005; Van Thiel et al, 1995, 2003; Waizmann & Ackermann, 2010; Wilkinson et al, 2009) (Litwin et al, 2015; Milne et al, 2015; Mason et al, 2015; Keats et al, 2015), and has been recommended for PWID by AASLD/IDSA and EASL guidelines following individualised assessment (AASLD/IDSA, 2015; European Association for Study of Liver, 2014). Therapy has evolved rapidly, with the recent approval of novel interferon-free DAA regimens that are highly effective and much better tolerated than those containing PEG-IFN (AASLD/IDSA, 2015; European Association for Study of Liver, 2014).…”

Section: Peg-ifn and Daa-based Treatment: Treatment Recommendationsmentioning

confidence: 99%

Recommendations for the management of hepatitis C virus infection among people who inject drugs

Grebely

Robaeys

Bruggmann

et al. 2015

International Journal of Drug Policy

163

132

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In high income countries, the majority of new and existing hepatitis C virus (HCV) infections occur among people who inject drugs (PWID). In many low and middle income countries large HCV epidemics have also emerged among PWID populations. The burden of HCV-related liver disease among PWID is increasing, but treatment uptake remains extremely low. There are a number of barriers to care which should be considered and systematically addressed, but should not exclude PWID from HCV treatment. The rapid development of interferon-free direct-acting antiviral (DAA) therapy for HCV infection has brought considerable optimism to the HCV sector, with the realistic hope that therapeutic intervention will soon provide near optimal efficacy with well-tolerated, short duration, all oral regimens. Further, it has been clearly demonstrated that HCV treatment is safe and effective across a broad range of multidisciplinary healthcare settings. Given the burden of HCV-related disease among PWID, strategies to enhance HCV assessment and treatment in this group are urgently needed. These recommendations demonstrate that treatment among PWID is feasible and provide a framework for HCV assessment and

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“…The other criteria (standard criteria for measuring the condition, valid and reliable way for measuring the outcomes and appropriate statistical analysis) were met by all studies. Sixteen studies fulfilled all the eight criteria …”

Section: Resultsmentioning

confidence: 99%

“…In eight studies, active drug users were excluded . Fourteen studies excluded patients with severe or uncontrolled mental health problems …”

Section: Resultsmentioning

confidence: 99%

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Clinical effectiveness, cost effectiveness and acceptability of community‐based treatment of hepatitis C virus infection: A mixed method systematic review

Pourmarzi

Hall

Hepworth

et al. 2019

Journal of Viral Hepatitis

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Summary Several community‐based models for treating hepatitis C virus (HCV) infection have been implemented to improve treatment accessibility and health outcomes. However, there is a lack of knowledge regarding how well these models achieve the desired goals. We conducted a mixed‐method systematic review of quantitative and qualitative evidence about clinical effectiveness, cost effectiveness and acceptability of community‐based HCV treatment models. Seventeen databases were researched for published and unpublished studies. Methodological quality was assessed using The Joanna Briggs Institute Critical Appraisal tools. Quantitative findings were synthesized in narrative form and qualitative findings were synthesized using meta‐synthesis. Forty‐two quantitative and six qualitative studies were included. No relevant cost effectiveness studies were found. Five categories of community‐based models were identified: telehealth, integration of HCV and addiction services, integration of HCV and HIV services, integration of HCV and primary care, and implementation by a home care and health care management company. The range of reported outcomes included; end of treatment response: 48.7% to 96%, serious side effects: 3.3% to 27.8%, sustained virological response: 22.3% to 95.5%, relapse: 2.2% to 16.7%, and treatment completion: 33.4% to 100%. Inconsistent measures of uptake and adherence were used; uptake ranged from 8.3% to 92%, and 68.4% to 100% of patients received ≥80% of prescribed doses. Patient reported experiences included trusted and supportive care providers, safe and trusted services, easily accessible care, and positive psychological and behavioural changes. The clinical effectiveness and acceptability reported from the included studies are similar to or better than reported outcomes from systematic reviews of studies in tertiary settings. Studies of the cost effectiveness of community‐based models for treating HCV are needed.

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Successful treatment of chronic hepatitis C with triple therapy in an opioid agonist treatment program

Cited by 20 publications

References 29 publications

Retention in buprenorphine treatment is associated with improved HCV care outcomes

Retention in buprenorphine treatment is associated with improved HCV care outcomes

Recommendations for the management of hepatitis C virus infection among people who inject drugs

Clinical effectiveness, cost effectiveness and acceptability of community‐based treatment of hepatitis C virus infection: A mixed method systematic review

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