April 4, 2017
Nearly three-quarters of HIV/hepatitis C (HCV)-coinfected drug users in Vancouver, Canada, reported willingness to use direct-activing antivirals (DAAs) for HCV infection, a substantial improvement over the willingness of this group to use interferon-based regimens. Enrollment in methadone maintenance programs predicted willingness to use DAAs.
Compared with HCV-monoinfected people, those coinfected with HIV are less likely to clear HCV spontaneously and more likely to progress to end-stage liver disease, hepatocellular carcinoma and death. HCV treatment rates have been low in drug injectors because potential patients may fear side effects, providers may be reluctant to prescribe for these people, and access to treatment may be low. Yet, research indicates that drug users achieve sustained virologic response rates similar to those of the general population.
To assess prevalence and correlates of willingness to use DAAs among HIV/HCV-coinfected drug users, researchers in Vancouver conducted this analysis of the ACCESS group, an ongoing prospective cohort of HIV-positive drug users. Cohort members are at least 18 years old, live in greater Vancouver and use illicit drugs other than marijuana. Cohort members complete an interviewer-administered questionnaire, which has included questions about HCV knowledge and willingness to use DAAs since June 2014.
Between June 2014 and May 2015, 418 HIV/HCV-coinfected cohort members completed the questionnaire. Median age stood at 44 years (interquartile range 37 to 48), 63% were men, 67% had seen an HCV specialist in the past six months and 53% were enrolled in methadone maintenance therapy. Whereas 95% of survey respondents were taking antiretroviral therapy, only 9% had received HCV therapy.
Overall, 295 of 418 survey respondents (71%) were willing to use DAA-based therapy. Among 220 respondents enrolled in methadone maintenance, a significantly higher proportion reported willingness to use DAAs than did not (57% versus 43%, P = .013). Willingness to use DAAs also proved significantly more prevalent in people who had seen an HCV specialist in the past six months and in those who perceived HCV as a health threat.
Adjusted logistic regression analysis identified these three factors as independent predictors of willingness to use DAAs: enrollment in methadone maintenance therapy (adjusted odds ratio [aOR] 1.61, 95% confidence interval [CI] 1.04 to 2.51), seeing an HCV specialist in the past six months (aOR 2.02, 95% CI 1.28 to 3.19) and perceiving HCV infection as a health threat (aOR 2.49, 95% CI 1.41 to 4.37).
The researchers note that the 71% HCV treatment willingness in this drug-using population "contrasts with historical low HCV treatment access and uptake" among drug users and that this contrast suggests "a substantial unmet need in HCV treatment coverage for this population." The association between DAA willingness and methadone maintenance therapy suggests to the authors that "integrated models of HIV, HCV and addiction care should be explored as a way to address HCV-related morbidity and mortality among HIV/HCV-coinfected [people who use drugs]." They caution that their use of a nonrandom sample may mean the findings do not apply to other HIV/HCV populations.
Mark Mascolini writes about HIV infection.
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