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Low Treatment & SVR Rates on MOUD - Medications for opioid use disorder (MOUD; eg, buprenorphine, methadone, and extended-release naltrexone), 10.6% SVR
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our primary aim was to assess the HCV treatment cascade among PWID with opioid use disorder (OUD) who were initiated on MOUD, specifically comparing persons with HIV (PWH) with those without HIV infection. Secondarily, we aimed to assess whether receipt of MOUD would modulate opioid IDU and stimulant use frequency, which are 2 risk factors that are associated with increased risk of HCV transmission.
To our knowledge, no previous studies have examined the HCV care cascade among HCV/HIV-coinfected persons in the context of receiving MOUD.
Forty-seven participants were previously untreated, of whom 37 (78.7%) attended a follow-up appointment, 26 (55.3%) underwent follow-up HCV VL testing, 20 (42.6%) were HCV VL positive, 6 (12.8%) were started on DAA therapy, and 5 (10.6%) achieved SVR (Figure 1A).
Our secondary analysis stems from data that were obtained from 2 National Institutes of Health-sponsored prospective observational cohort studies, Project MAT BIO (The Impact of HIV Infection on Immunologic, Transcriptomic, and Metabolomic Signatures of Medication-Assisted Therapy for Opioid Addiction) [25] and Persistence (Evaluating the Role of Medication Treatments for OUD in HIV-1 Persistence for PWH and OUD) [26].
Participants were predominately male, White, and non-Hispanic (Table 1). All participants with HIV were on ART and virally suppressed at baseline and 3-month follow-up. Approximately one-third (n = 40, 31%) of participants were homeless in the 30 days before study enrollment (Table 1). Buprenorphine (n = 68, 52.7%) and methadone (n = 55, 42.6%) were the 2 most frequent forms of MOUD, followed by extended-release naltrexone (n = 6, 4.7%). HCV antibody serostatus was high (n = 78, 60.5%), particularly among PWH (n = 40, 83.3%).
A significant proportion of participants had utilized opioids in the 3 months before study enrollment (n = 112, 86.8%), predominantly with intravenous heroin (n = 49, 38.3%). Eighty-two (63.6%) participants had a urine toxicology screen that was positive for heroin, while 27 (20.9%) participants were positive for fentanyl. Sixty-one (47.3%) participants endorsed cocaine use in the past 3 months, while 5 (3.9%) participants, all persons without HIV, endorsed methamphetamine use. Fifty-six (46.7%) participants had a DSM-5 diagnosis of cocaine use disorder via the MINI.
Participants without HIV were more likely to carry a diagnosis of bipolar disorder. Retention in the parent cohort study project interviews was 66.7% at month 3 follow-up, and retention on MOUD for those who had an interview at each time point was 91%, 80%, and 78% at months 1, 3, and 6, respectively, for MAT BIO [25], as well as 89% and 72% at months 1 and 3 for Persistence [26].
HCV Care Cascade
Among the 129 subjects, 78 (60.5%) were HCV antibody positive, of whom 61 self-reported a positive HCV status before baseline testing and 31 (39.7%) self-reported receipt of previous treatment, with 28 (87.5%) endorsing a sustained virologic response (SVR). SVR was confirmed with HCV VL testing by study staff. One previously treated participant without HIV was reinfected with HCV. Forty-seven participants were previously untreated, of whom 37 (78.7%) attended a follow-up appointment, 26 (55.3%) underwent follow-up HCV VL testing, 20 (42.6%) were HCV VL positive, 6 (12.8%) were started on DAA therapy, and 5 (10.6%) achieved SVR (Figure 1A). When grouped by HIV serostatus, participants without HIV underwent a significantly lower rate of follow-up HCV VL confirmatory testing (43.3% vs 76.5%; P = .03) (Figure 1B and C). There was no significant difference with respect to initiation onto (17.6% PWH vs persons without HIV 10%; P = .45) or completion of DAA therapy (11.8% PWH vs persons without HIV 10%; P = .85). Twenty-four PWH self-reported previous receipt of HCV treatment (83.3% endorsing SVR) at enrollment compared with 8 participants (100% endorsed SVR) without HIV.
Evaluation of the Impact of HIV Serostatus on the Hepatitis C Virus Care Cascade and Injection Drug Use Among Persons Initiating Medication Treatment for Opioid Use Disorder
14 November 2022
Abstract
Background
Persons who inject drugs are at increased risk for acquiring hepatitis C virus (HCV). Medications for opioid use disorder (MOUD) are associated with reduced injection drug use (IDU) frequency among persons with opioid use disorder (OUD). However, whether HCV treatment uptake or changes in IDU frequency differ by HIV serostatus among persons receiving MOUD is incompletely understood.
The HCV care cascade reflects a high rate of HCV antibody testing and follow-up appointment attendance; however, there was diminished HCV VL testing and initiation onto DAAs. Most notably, in this evaluation there was a significantly lower number of participants without HIV who completed follow-up HCV VL testing compared with PWH after receiving the same referral to a commercial laboratory.
Methods
A secondary analysis was performed of data collected from 2 prospective cohort studies of participants with (PWH) or without HIV with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition-diagnosed OUD who were initiated on methadone, buprenorphine, or naltrexone.
Results
Of 129 participants, 78 (60.5%) were HCV antibody positive. PWH underwent increased HCV viral load testing (76.7% vs 43.3%; P = .028), but HCV treatment rates did not differ (17.6% vs 10.0%; P = .45) by HIV status. Participants without HIV reported a greater reduction in mean opioid IDU at 90 days (10.7 vs 2.0 fewer days out of 30; P < .001), but there were no group differences at 90 days. Stimulant use did not differ between groups. Urine opioid positivity declined from baseline to 90 days among the entire cohort (61.4% to 38.0%; P < .001) but did not differ by HIV serostatus.
Conclusions
PWH who received MOUD underwent higher rates of follow-up HCV testing, but HCV treatment rates did not significantly differ by HIV serostatus. Participants without HIV on MOUD reported a greater reduction in opioid IDU. Improved integration of concomitant OUD with HCV and HIV screening, linkage to care, and treatment are needed for persons without HIV.
Injection Opioid Use
In an unadjusted model of injection opioid use, we observed a significant reduction in use over observations (P < .001), with a significant main effect of HIV status (P < .001), and a significant HIV*observation interaction (P < .001) (Figure 2A). Most participants endorsed injection heroin use, as reflected in the IDU variable. Participants without HIV notably self-reported a higher proportion of opioid IDU at baseline compared with PWH (21.0 days vs 11.2 days out of 30; P < .001) and experienced a much larger decline in self-reported opioid IDU from day 0 to day 90 after initiating MOUD (10.7 fewer days vs 2.0 fewer days out of 30; P < .001). Among the entire cohort, the number of positive opioid urine toxicology samples was statistically significantly reduced from baseline to 90 days (61.4% to 38.0%; P < .001); however, there was no significant difference when stratified by HIV serostatus (48.9% to 32.9% PWH vs 72.5% to 43.2% persons without HIV; P = .22). Next, when adjusting for baseline differences in gender, age, race, educational attainment, housing status, and MOUD, the only covariate that was significant was the form of MOUD, with participants receiving buprenorphine endorsing lower opioid IDU from baseline to 90 days (P < .05), compared with participants receiving methadone.
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