Study shows benefits of treating opioid addiction, HCV at same time
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Data from a recent study showed the benefits of initiating opioid agonist therapy and hepatitis C treatment at the same time in patients with opioid use disorder and ongoing injection drug use. Benefits included a high rate of SVR and lower rates of drug use, HIV risk-taking behaviors and overdose.
In the ANCHOR study, Elana Rosenthal, MD, assistant professor at the University of Maryland School of Medicine Institute of Human Virology, and colleagues treated 100 patients with chronic HCV, opioid use disorder (OUD) and ongoing injection drug use with sofosbuvir/velpatasvir for 12weeks and offered them buprenorphine initiation. The prospective, open-label, observational trial was conducted at a harm reduction drop-in center in Washington, D.C.
“We wanted to do a study of patients with active injection drug use of opioids to assess if patients with ongoing drug use could achieve cure rates comparable to non-using populations, but we also wanted to acknowledge that, in these patients, HCV was a symptom of the patient’s underlying opioid use disorder,” Rosenthal told Healio. “We felt an imperative to provide evidence-based treatment for OUD in the same way that we would treat someone’s elevated cholesterol if they came in with a heart attack.”
‘An opportunity’
Rosenthal said patients were “eager” to receive HCV treatment, “and when they were turned away, it further reinforced a distrust in the healthcare system that already exists for many people who use drugs.”
“Our hope was that, rather than demanding abstinence prior to treatment, we could tilizeHCV treatment as an opportunity to create a therapeutic relationship with a marginalized population, leverage this relationship to reduce harm associated with drug use and potentially engage them in treatment of opioid use disorder, in addition to HCV treatment,” she said.
The primary endpoint was , and secondary endpoints were uptake of and retention in OAT, change in risk behavior and determinants of SVR.
Results showed that 82% patients achieved SVR, which was not associated with baseline OAT status, on-treatment drug-use or imperfect daily adherence but was significantly associated with completing two or more bottles of sofosbuvir/velpatasvir and being on OAT at week 24, Rosenthal and colleagues reported.
During the study, 53 of 67 patients not on baseline OAT initiated OAT. At week 24, 68% patients were on OAT, which was associated with fewer opiate-positive urine drug screens, lower HIV risk-taking behavior scores and lower rates of opioid overdose, according to the researchers.
“People who use drugs can and should be treated for HCV,” Rosenthal said. “Concerns about ongoing drug use and adherence impacting HCV cure are not supported in the literature and should not be used to justify excluding this population from treatment. Further, utilizing HCV treatment as an opportunity to engage people who inject drugs in treatment for opioid use disorder not only improves HCV outcomes, but can reduce harms associated with drug use as well.”
ID clinicians ‘ready’ to treat OUD
In an accompanying article, Sandra A. Springer, MD, an associate professor and director of the infectious disease outpatient clinic at the Yale School of Medicine, and Carlos del Rio, MD, executive associate dean at Emory University School of Medicine, said that the study “identifies importantly that cotreating infectious diseases and [s]can lead to reduced morbidity and mortality from two diseases.”
Springer told Healio that infectious disease clinicians are “ready” to take on treatment for opioid use in people who inject drugs (PWID).
“When you think of the word epidemic, what do you think of? Infectious diseases, right — influenza and now coronavirus? But also remember our early HIV epidemic in the United States in 1980s1990s fueled not just by condomless sex but injection drug use of opioids and cocaine,” Springer said. “We were able to overcome that epidemic due to huge efforts by federal and state agencies to include access to life saving medicines, training and education of clinicians and federal and state funding through the Ryan White Care Act.”
Springer said physicians are well equipped to cotreat and infectious diseases like HCV and HIV, noting that they have the most experience working with populations that have suffered due to social determinants of health such as poverty, housing instability, unemployment criminal involvement — all of which increase the likelihood of having substance use disorders and related infectious diseases like HIV and HCV.
However, she said not all clinicians are ready due to barriers including the waiver training to prescribe buprenorphine, which requires 8 hours for and 24 hours for non, is “not relevant to real world” and puts a limitation on the number of patients one can treat, as well as other burdens.
Rosenthal said doctors are not being sufficiently prepared during medical school and residency to manage patients with OUD.
“It’s a major deficit in the care of this population,” she said. “However, there are a lot of infectious disease doctors learning to provide compassionate, evidence-based treatment for these patients in order to improve outcomes — infectious and otherwise.
“Hopefully, healthcare systems will follow suit and ensure that this training is universal for all medical providers. In the meantime, there are a lot of free resources available to help ID doctors become more comfortable treating people with opioid use disorder.” – by Caitlyn Stulpin
Disclosures: Rosenthal reports grants and non-financial support from Gilead Sciences and Merck to the institution. Springer reports grants from the NIH and Veterans Affairs cooperative studies programs, and consulting fees form Alkermes Inc, Clinical Care Options, and DK Inc, outside the submitted work. Please see the study and editorial for all other authors’ relevant financial disclosures.
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Rosenthal ES, et al. Clin Infect Dis. 2020;doi:10.1093/cid/ciaa105.
Springer SA, et al. Clin Infect Dis. 2020;doi:10.1093/cid/ciaa111.
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