在丙型肝炎病毒直接作用抗病毒治疗期间和之后，使用直接作用抗病毒药物治疗的近期注射吸毒或接受阿片类激动剂治疗者的药物和酒精使用模式及注射设备共用情况：一项国际研究。
Patterns of Drug and Alcohol Use and Injection Equipment Sharing Among People With Recent Injecting Drug Use or Receiving Opioid Agonist Treatment During and Following Hepatitis C Virus Treatment With Direct-acting Antiviral Therapies: An International Study.
机构信息
Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Canada.
Research Centre, Centre Hospitalier de l'Université de Montréal, Canada.
出版信息
Clin Infect Dis. 2020 May 23;70(11):2369-2376. doi: 10.1093/cid/ciz633.
BACKGROUND
In many settings, recent or prior injection drug use remains a barrier to accessing direct-acting antiviral treatment (DAA) for hepatitis C virus (HCV) infection. We examined patterns of drug and alcohol use and injection equipment sharing among people with recent injecting drug use or receiving opioid agonist treatment (OAT) during and following DAA-based treatment.
METHODS
SIMPLIFY and D3FEAT are phase 4 trials evaluating the efficacy of DAA among people with past 6-month injecting drug use or receiving OAT through a network of 25 international sites. Enrolled in 2016-2017, participants received sofosbuvir/velpatasvir (SIMPLIFY) or paritaprevir/ritonavir/dasabuvir/ombitasvir ± ribavirin (D3FEAT) for 12 weeks and completed behavioral questionnaires before, during, and up to 2 years posttreatment. The impact of time in HCV treatment and follow-up on longitudinally measured longitudinally measured behaviors was estimated using generalized estimating equations.
RESULTS
At screening, of 190 participants (mean age, 47 years; 74% male), 62% reported any past-month injecting 16% past-month injection equipment sharing, and 61% current OAT. Median alcohol use was 2 (Alcohol Use Disorders Identification Test-Consumption; range, 1-12). During follow-up, opioid injecting (odds ratio [OR], 0.95; 95% confidence interval [CI], 0.92-0.99) and sharing (OR, 0.87; 95% CI, 0.80-0.94) decreased, whereas no significant changes were observed for stimulant injecting (OR, 0.98; 95% CI, 0.94-1.02) or alcohol use (OR, 0.99; 95% CI, 0.95-1.04).
CONCLUSIONS
Injecting drug use and risk behaviors remained stable or decreased following DAA-based HCV treatment. Findings further support expanding HCV treatment to all, irrespective of injection drug use.
CLINICAL TRIALS REGISTRATION
SIMPLIFY, NCT02336139; D3FEAT, NCT02498015.
背景
在许多情况下，最近或之前的注射吸毒仍然是获得丙型肝炎病毒 (HCV) 感染直接作用抗病毒治疗 (DAA) 的障碍。我们研究了在接受 DAA 治疗期间和之后，最近有注射吸毒史或接受阿片类药物激动剂治疗 (OAT) 的人在药物和酒精使用以及注射器具共享方面的模式。
方法
SIMPLIFY 和 D3FEAT 是两项评估过去 6 个月有注射吸毒史或接受 OAT 的人通过 25 个国际站点网络接受 DAA 治疗的疗效的 4 期试验。参与者于 2016 年至 2017 年入组，接受索磷布韦/维帕他韦（SIMPLIFY）或帕利瑞韦/利托那韦/达沙布韦/奥比他韦 ± 利巴韦林（D3FEAT）治疗 12 周，并在治疗前、治疗期间和治疗后长达 2 年完成行为问卷。使用广义估计方程估计 HCV 治疗和随访时间对纵向测量的行为的影响。
结果
在筛选时，190 名参与者（平均年龄 47 岁；74%为男性）中，62%报告过去一个月有注射吸毒，16%报告过去一个月有注射吸毒器具共享，61%报告目前正在接受 OAT。酒精使用中位数为 2（酒精使用障碍识别测试-摄入量；范围，1-12）。在随访期间，阿片类药物注射（比值比[OR]，0.95；95%置信区间[CI]，0.92-0.99）和共享（OR，0.87；95%CI，0.80-0.94）减少，而兴奋剂注射（OR，0.98；95%CI，0.94-1.02）或酒精使用（OR，0.99；95%CI，0.95-1.04）无显著变化。
结论
在接受 DAA 治疗后，注射吸毒和风险行为保持稳定或减少。研究结果进一步支持扩大 HCV 治疗范围，涵盖所有人群，无论是否有注射吸毒史。
临床试验注册
SIMPLIFY，NCT02336139；D3FEAT，NCT02498015。
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