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

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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

Keywords

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

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