Evidence of continued injecting drug use after attaining sustained treatment-induced clearance of the hepatitis C virus: implications for reinfection

Heather Valerio, David Goldberg, James Lewsey, Amanda Weir, Samuel Allen, Esther J. Aspinall, Stephen T. Barclay , Peter Bramley, John F. Dillon, Ray Fox, Andrew Fraser, Peter C. Hayes, Hamish Innes, Nicholas Kennedy, Peter R. Mills, Adrian J. Stanley, Sharon J. Hutchinson

Research output: Contribution to journalArticle

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Abstract

Background
People who inject drugs (PWID) are at the greatest risk of hepatitis C virus (HCV) infection, yet are often denied immediate treatment due to fears of on-going risk behaviour. Our principal objective was to examine evidence of continued injecting drug use among PWID following successful treatment for HCV and attainment of a sustained viral response (SVR).

Methods
PWID who attained SVR between 1992 and June 2012 were selected from the National Scottish Hepatitis C Clinical Database. Hospitalisation and mortality records were sourced for these patients using record linkage techniques. Our primary outcome variable was any hospitalisation or death, which was indicative of injecting drugs post-SVR.

Results
The cohort comprised 1170 PWID (mean age at SVR 39.6y; 76% male). The Kaplan Meier estimate of incurring the primary outcome after three years of SVR was 10.59% (95% CI, 8.75–12.79) After adjusting for confounding, the risk of an injection related hospital episode or death post-SVR was significantly increased with advancing year of SVR: AHR:1.07 per year (95% CI, 1.01–1.14), having a pre-SVR acute alcohol intoxication-related hospital episode: AHR:1.83 (95% CI, 1.29–2.60), and having a pre-SVR opiate or injection-related hospital episode: AHR:2.59 (95% CI, 1.84–3.64).

Conclusion
Despite attaining the optimal treatment outcome, these data indicate that an increasing significant minority of PWID continue to inject post-SVR at an intensity which leads to either hospitalisation or death and increased risk of reinfection.
Original languageEnglish
Pages (from-to)125-131
Number of pages7
JournalDrug and Alcohol Dependence
Volume154
Publication statusPublished - 1 Sep 2015

Fingerprint

Viruses
Hepacivirus
Hospitalization
Opiate Alkaloids
Pharmaceutical Preparations
Alcoholic Intoxication
Injections
Kaplan-Meier Estimate
Virus Diseases
Hepatitis C
Risk-Taking
Fear
Therapeutics
Databases
Mortality
Alcohols

Keywords

  • Hepatitis C
  • sustained viral response
  • people who inject drugs
  • reinfection
  • record linkage

Cite this

Valerio, Heather ; Goldberg, David ; Lewsey, James ; Weir, Amanda ; Allen, Samuel ; Aspinall, Esther J. ; Barclay , Stephen T. ; Bramley, Peter ; Dillon, John F. ; Fox, Ray ; Fraser, Andrew ; Hayes, Peter C. ; Innes, Hamish ; Kennedy, Nicholas ; Mills, Peter R. ; Stanley, Adrian J. ; Hutchinson, Sharon J. / Evidence of continued injecting drug use after attaining sustained treatment-induced clearance of the hepatitis C virus: implications for reinfection. In: Drug and Alcohol Dependence. 2015 ; Vol. 154. pp. 125-131.
@article{dd7cfb87760142e0abfc49ce7841b68b,
title = "Evidence of continued injecting drug use after attaining sustained treatment-induced clearance of the hepatitis C virus: implications for reinfection",
abstract = "BackgroundPeople who inject drugs (PWID) are at the greatest risk of hepatitis C virus (HCV) infection, yet are often denied immediate treatment due to fears of on-going risk behaviour. Our principal objective was to examine evidence of continued injecting drug use among PWID following successful treatment for HCV and attainment of a sustained viral response (SVR).MethodsPWID who attained SVR between 1992 and June 2012 were selected from the National Scottish Hepatitis C Clinical Database. Hospitalisation and mortality records were sourced for these patients using record linkage techniques. Our primary outcome variable was any hospitalisation or death, which was indicative of injecting drugs post-SVR.ResultsThe cohort comprised 1170 PWID (mean age at SVR 39.6y; 76{\%} male). The Kaplan Meier estimate of incurring the primary outcome after three years of SVR was 10.59{\%} (95{\%} CI, 8.75–12.79) After adjusting for confounding, the risk of an injection related hospital episode or death post-SVR was significantly increased with advancing year of SVR: AHR:1.07 per year (95{\%} CI, 1.01–1.14), having a pre-SVR acute alcohol intoxication-related hospital episode: AHR:1.83 (95{\%} CI, 1.29–2.60), and having a pre-SVR opiate or injection-related hospital episode: AHR:2.59 (95{\%} CI, 1.84–3.64).ConclusionDespite attaining the optimal treatment outcome, these data indicate that an increasing significant minority of PWID continue to inject post-SVR at an intensity which leads to either hospitalisation or death and increased risk of reinfection.",
keywords = "Hepatitis C, sustained viral response, people who inject drugs, reinfection, record linkage",
author = "Heather Valerio and David Goldberg and James Lewsey and Amanda Weir and Samuel Allen and Aspinall, {Esther J.} and Barclay, {Stephen T.} and Peter Bramley and Dillon, {John F.} and Ray Fox and Andrew Fraser and Hayes, {Peter C.} and Hamish Innes and Nicholas Kennedy and Mills, {Peter R.} and Stanley, {Adrian J.} and Hutchinson, {Sharon J.}",
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journal = "Drug and Alcohol Dependence",
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Valerio, H, Goldberg, D, Lewsey, J, Weir, A, Allen, S, Aspinall, EJ, Barclay , ST, Bramley, P, Dillon, JF, Fox, R, Fraser, A, Hayes, PC, Innes, H, Kennedy, N, Mills, PR, Stanley, AJ & Hutchinson, SJ 2015, 'Evidence of continued injecting drug use after attaining sustained treatment-induced clearance of the hepatitis C virus: implications for reinfection', Drug and Alcohol Dependence, vol. 154, pp. 125-131.

Evidence of continued injecting drug use after attaining sustained treatment-induced clearance of the hepatitis C virus: implications for reinfection. / Valerio, Heather; Goldberg, David; Lewsey, James; Weir, Amanda; Allen, Samuel; Aspinall, Esther J.; Barclay , Stephen T. ; Bramley, Peter; Dillon, John F.; Fox, Ray; Fraser, Andrew; Hayes, Peter C.; Innes, Hamish; Kennedy, Nicholas; Mills, Peter R.; Stanley, Adrian J.; Hutchinson, Sharon J.

In: Drug and Alcohol Dependence, Vol. 154, 01.09.2015, p. 125-131.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Evidence of continued injecting drug use after attaining sustained treatment-induced clearance of the hepatitis C virus: implications for reinfection

AU - Valerio, Heather

AU - Goldberg, David

AU - Lewsey, James

AU - Weir, Amanda

AU - Allen, Samuel

AU - Aspinall, Esther J.

AU - Barclay , Stephen T.

AU - Bramley, Peter

AU - Dillon, John F.

AU - Fox, Ray

AU - Fraser, Andrew

AU - Hayes, Peter C.

AU - Innes, Hamish

AU - Kennedy, Nicholas

AU - Mills, Peter R.

AU - Stanley, Adrian J.

AU - Hutchinson, Sharon J.

PY - 2015/9/1

Y1 - 2015/9/1

N2 - BackgroundPeople who inject drugs (PWID) are at the greatest risk of hepatitis C virus (HCV) infection, yet are often denied immediate treatment due to fears of on-going risk behaviour. Our principal objective was to examine evidence of continued injecting drug use among PWID following successful treatment for HCV and attainment of a sustained viral response (SVR).MethodsPWID who attained SVR between 1992 and June 2012 were selected from the National Scottish Hepatitis C Clinical Database. Hospitalisation and mortality records were sourced for these patients using record linkage techniques. Our primary outcome variable was any hospitalisation or death, which was indicative of injecting drugs post-SVR.ResultsThe cohort comprised 1170 PWID (mean age at SVR 39.6y; 76% male). The Kaplan Meier estimate of incurring the primary outcome after three years of SVR was 10.59% (95% CI, 8.75–12.79) After adjusting for confounding, the risk of an injection related hospital episode or death post-SVR was significantly increased with advancing year of SVR: AHR:1.07 per year (95% CI, 1.01–1.14), having a pre-SVR acute alcohol intoxication-related hospital episode: AHR:1.83 (95% CI, 1.29–2.60), and having a pre-SVR opiate or injection-related hospital episode: AHR:2.59 (95% CI, 1.84–3.64).ConclusionDespite attaining the optimal treatment outcome, these data indicate that an increasing significant minority of PWID continue to inject post-SVR at an intensity which leads to either hospitalisation or death and increased risk of reinfection.

AB - BackgroundPeople who inject drugs (PWID) are at the greatest risk of hepatitis C virus (HCV) infection, yet are often denied immediate treatment due to fears of on-going risk behaviour. Our principal objective was to examine evidence of continued injecting drug use among PWID following successful treatment for HCV and attainment of a sustained viral response (SVR).MethodsPWID who attained SVR between 1992 and June 2012 were selected from the National Scottish Hepatitis C Clinical Database. Hospitalisation and mortality records were sourced for these patients using record linkage techniques. Our primary outcome variable was any hospitalisation or death, which was indicative of injecting drugs post-SVR.ResultsThe cohort comprised 1170 PWID (mean age at SVR 39.6y; 76% male). The Kaplan Meier estimate of incurring the primary outcome after three years of SVR was 10.59% (95% CI, 8.75–12.79) After adjusting for confounding, the risk of an injection related hospital episode or death post-SVR was significantly increased with advancing year of SVR: AHR:1.07 per year (95% CI, 1.01–1.14), having a pre-SVR acute alcohol intoxication-related hospital episode: AHR:1.83 (95% CI, 1.29–2.60), and having a pre-SVR opiate or injection-related hospital episode: AHR:2.59 (95% CI, 1.84–3.64).ConclusionDespite attaining the optimal treatment outcome, these data indicate that an increasing significant minority of PWID continue to inject post-SVR at an intensity which leads to either hospitalisation or death and increased risk of reinfection.

KW - Hepatitis C

KW - sustained viral response

KW - people who inject drugs

KW - reinfection

KW - record linkage

M3 - Article

VL - 154

SP - 125

EP - 131

JO - Drug and Alcohol Dependence

JF - Drug and Alcohol Dependence

SN - 0376-8716

ER -