Efficacy of response-guided directly observed pegylated interferon and self-administered ribavirin for people who inject drugs with hepatitis C virus genotype 2/3 infection: The ACTIVATE study.

Grebely, Jason; Dalgard, Olav; Cunningham, Evan B; Hajarizadeh, Behzad; Foster, Graham R; Bruggmann, Philip; Conway, Brian; Backmund, Markus; Robaeys, Geert; Swan, Tracy; Amin, Janaki; Marks, Philippa S; Quiene, Sophie; Applegate, Tanya L; Weltman, Martin; Shaw, David; Dunlop, Adrian; Hellard, Margaret; Bruneau, Julie; Midgard, Håvard; ... (2017). Efficacy of response-guided directly observed pegylated interferon and self-administered ribavirin for people who inject drugs with hepatitis C virus genotype 2/3 infection: The ACTIVATE study. The international journal of drug policy, 47, pp. 177-186. Elsevier 10.1016/j.drugpo.2017.05.020

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BACKGROUND There are few data on treatment for hepatitis C virus (HCV) infection among people with ongoing injecting drug use. This study evaluated the efficacy of response-guided therapy for chronic HCV genotypes 2/3 infection among people with ongoing injecting drug use or receiving opioid substitution therapy (OST). A secondary aim was to identify predictors of HCV treatment response. METHODS ACTIVATE was a multicentre clinical trial recruited between 2012 and 2014. Participants with genotypes 2/3 were treated with directly observed peg-interferon alfa-2b and self-administered ribavirin for 12 (undetectable HCV RNA at week 4) or 24 weeks (detectable HCV RNA at week 4). Participants were recruited from drug treatment clinics, private practices, hospital clinics and community clinics in Australia, Canada, and five countries in Europe. The primary study outcome was sustained virological response (SVR, undetectable HCV RNA >12 weeks post-treatment). RESULTS Among 93 people with ongoing injecting drug use or receiving OST treated for HCV genotype 2/3, 59% had recently (past month) injected drugs, 77% were receiving OST and 56% injected drugs during therapy. Overall SVR was 66% (61/93). SVR was 84% in those with undetectable HCV RNA at week 4 (12 weeks) compared to 38% in those without (24 weeks). In adjusted analysis, cirrhosis vs. no/mild fibrosis [adjusted OR (aOR) 0.33, 95% CI 0.13, 0.86] predicted reduced SVR, while response at week 4 was associated with increased SVR [aOR 8.11, 95% CI 2.73, 24.10]. Recent injecting drug use at baseline or during therapy was not associated with SVR. CONCLUSION This study demonstrates that people with recent injecting drug use or OST with chronic HCV can achieve responses to interferon-based therapy similar to other populations, despite injecting drugs prior to or during therapy. Cirrhosis was predictive of reduced response to HCV therapy, while response at week 4 (despite shortened therapy) was predictive of improved response.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Infectiology

UniBE Contributor:

Stähelin, Cornelia Johanna

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1873-4758

Publisher:

Elsevier

Language:

English

Submitter:

Annelies Luginbühl

Date Deposited:

07 Nov 2017 18:10

Last Modified:

08 Nov 2017 06:33

Publisher DOI:

10.1016/j.drugpo.2017.05.020

PubMed ID:

28624134

Uncontrolled Keywords:

Drug use HCV treatment Hepatitis C PWID

BORIS DOI:

10.7892/boris.101596

URI:

https://boris.unibe.ch/id/eprint/101596

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