British Columbia Centre on Substance Use, Vancouver, BC, Canada; Division of Social Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada.
ICES McMaster, McMaster University, Hamilton, Ontario, Canada.
J Subst Use Addict Treat. 2024 Dec;167:209524. doi: 10.1016/j.josat.2024.209524. Epub 2024 Sep 26.
Among patients with opioid use disorder (OUD), high rates of overdose and death have been reported in subgroups with Hepatitis C Virus (HCV). Evidence on the comorbid effect of HCV on clinical and substance use trajectories has been limited by small sample sizes, short follow-up, and heavy reliance on administrative data which lacks granularity on important prognostic factors. Additionally, few studies include populations on substance use treatment.
To establish the impact of HCV exposure (antibody positivity) on health care utilization patterns, substance use treatment response, and death in a cohort of patients with OUD on opioid agonist therapy (OAT).
This multi-center prospective cohort study recruited adult patients with OUD on OAT from 57 substance use treatment centers in Ontario, Canada. The study collected substance use outcomes, and classified patients with ≥50 % positive opioid urine screens over one year of follow-up as having poor treatment response. Additional data obtained via linkage with ICES administrative databases evaluated the relationship between HCV status, healthcare service utilization, and death over 3 years of follow-up. Multiple logistic regression models established the adjusted impact of HCV on various outcomes.
Among recruited participants (n = 3430), 44.10 % were female with a mean age of 38.64 years (Standard deviation: 10.96). HCV was prevalent in 10.6 % of the cohort (n = 365). Methadone was used most often (83.9 %, n = 2876), followed by sublingual buprenorphine (16.2 %, n = 554). Over the three-year follow-up, 5.3 % of patients died (n = 181). Unadjusted results reveal rates of hospitalization (all-cause, mental-health related, critical care) and emergency department visits (mental health-related), were significantly higher among HCV patients. Associations diminished in adjusted models. Active injection drug use exhibited the highest predictive risk for all outcomes.
A high degree of acute physical and mental illness and its resulting health service utilization burden is concentrated among patients with OUD and comorbid HCV. Future research should explore the role for targeted interventions and how best to implement integrated healthcare models to better address the complex health needs of HCV populations who inject drugs.
在患有阿片类药物使用障碍（OUD）的患者中，有报道称丙型肝炎病毒（HCV）亚组患者的过量用药和死亡率较高。由于样本量小、随访时间短以及严重依赖缺乏重要预后因素详细信息的行政数据，有关 HCV 合并症对临床和物质使用轨迹的影响的证据有限。此外，很少有研究包括接受物质使用治疗的人群。
在接受阿片类激动剂治疗（OAT）的 OUD 患者队列中，确定 HCV 暴露（抗体阳性）对医疗保健利用模式、物质使用治疗反应和死亡的影响。
这项多中心前瞻性队列研究从加拿大安大略省的 57 个物质使用治疗中心招募了接受 OAT 的成年 OUD 患者。该研究收集了物质使用结果，并将在一年随访期间有≥50%阳性阿片类药物尿液检测结果的患者归类为治疗反应差。通过与 ICES 行政数据库的链接获得的其他数据评估了 HCV 状态、医疗保健服务利用与 3 年随访期间死亡之间的关系。多变量逻辑回归模型确定了 HCV 对各种结局的调整影响。
在招募的参与者（n=3430）中，44.1%为女性，平均年龄为 38.64 岁（标准差：10.96）。队列中有 10.6%（n=365）的患者 HCV 阳性。最常使用的是美沙酮（83.9%，n=2876），其次是舌下丁丙诺啡（16.2%，n=554）。在 3 年的随访期间，有 5.3%的患者死亡（n=181）。未调整的结果显示，HCV 患者的住院率（全因、精神健康相关、重症监护）和急诊科就诊率（精神健康相关）均显著更高。调整后的模型中，这些关联有所减弱。活跃的注射吸毒行为是所有结局的最高预测风险因素。
患有 OUD 合并 HCV 的患者集中表现出高度的急性躯体和精神疾病及其导致的医疗服务利用负担。未来的研究应探讨有针对性干预措施的作用以及如何最好地实施综合医疗模式，以更好地满足注射毒品的 HCV 人群的复杂健康需求。
