Heather Valerio1, David J Goldberg2, James Lewsey3, Amanda Weir4, Samuel Allen5, Esther J Aspinall4, Stephen T Barclay6, Peter Bramley7, John F Dillon8, Ray Fox9, Andrew Fraser10, Peter C Hayes11, Hamish Innes4, Nicholas Kennedy12, Peter R Mills9, Adrian J Stanley6, Sharon J Hutchinson4. 1. School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Blood-borne Viruses and Sexually Transmitted Infections Section, Health Protection Scotland, Glasgow, UK. Electronic address: Heather.valerio@nhs.net. 2. Blood-borne Viruses and Sexually Transmitted Infections Section, Health Protection Scotland, Glasgow, UK; School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK. 3. Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK. 4. School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK; Blood-borne Viruses and Sexually Transmitted Infections Section, Health Protection Scotland, Glasgow, UK. 5. Crosshouse Hospital, Kilmarnock, UK. 6. Glasgow Royal Infirmary, Glasgow, UK. 7. Stirling Community Hospital, Stirling, UK. 8. Ninewells Hospital and Medical School, Dundee, UK. 9. Gartnavel General Hospital, Glasgow, UK. 10. Aberdeen Royal Infirmary, Aberdeen, UK. 11. Royal Infirmary Edinburgh, Edinburgh, UK. 12. Monklands Hospital, Lanarkshire, UK.
Abstract
BACKGROUND: People who inject drugs (PWID) are at the greatest risk of hepatitis C virus (HCV) infection, yet are often denied immediate treatment due to fears of on-going risk behaviour. Our principal objective was to examine evidence of continued injecting drug use among PWID following successful treatment for HCV and attainment of a sustained viral response (SVR). METHODS: PWID who attained SVR between 1992 and June 2012 were selected from the National Scottish Hepatitis C Clinical Database. Hospitalisation and mortality records were sourced for these patients using record linkage techniques. Our primary outcome variable was any hospitalisation or death, which was indicative of injecting drugs post-SVR. RESULTS: The cohort comprised 1170 PWID (mean age at SVR 39.6y; 76% male). The Kaplan Meier estimate of incurring the primary outcome after three years of SVR was 10.59% (95% CI, 8.75-12.79) After adjusting for confounding, the risk of an injection related hospital episode or death post-SVR was significantly increased with advancing year of SVR: AHR:1.07 per year (95% CI, 1.01-1.14), having a pre-SVR acute alcohol intoxication-related hospital episode: AHR:1.83 (95% CI, 1.29-2.60), and having a pre-SVR opiate or injection-related hospital episode: AHR:2.59 (95% CI, 1.84-3.64). CONCLUSION: Despite attaining the optimal treatment outcome, these data indicate that an increasing significant minority of PWID continue to inject post-SVR at an intensity which leads to either hospitalisation or death and increased risk of reinfection.
BACKGROUND:People who inject drugs (PWID) are at the greatest risk of hepatitis C virus (HCV) infection, yet are often denied immediate treatment due to fears of on-going risk behaviour. Our principal objective was to examine evidence of continued injecting drug use among PWID following successful treatment for HCV and attainment of a sustained viral response (SVR). METHODS: PWID who attained SVR between 1992 and June 2012 were selected from the National Scottish Hepatitis C Clinical Database. Hospitalisation and mortality records were sourced for these patients using record linkage techniques. Our primary outcome variable was any hospitalisation or death, which was indicative of injecting drugs post-SVR. RESULTS: The cohort comprised 1170 PWID (mean age at SVR 39.6y; 76% male). The Kaplan Meier estimate of incurring the primary outcome after three years of SVR was 10.59% (95% CI, 8.75-12.79) After adjusting for confounding, the risk of an injection related hospital episode or death post-SVR was significantly increased with advancing year of SVR: AHR:1.07 per year (95% CI, 1.01-1.14), having a pre-SVR acute alcohol intoxication-related hospital episode: AHR:1.83 (95% CI, 1.29-2.60), and having a pre-SVR opiate or injection-related hospital episode: AHR:2.59 (95% CI, 1.84-3.64). CONCLUSION: Despite attaining the optimal treatment outcome, these data indicate that an increasing significant minority of PWID continue to inject post-SVR at an intensity which leads to either hospitalisation or death and increased risk of reinfection.
Authors: Gail Gilchrist; Davina Swan; April Shaw; Ada Keding; Sarah Towers; Noel Craine; Alison Munro; Elizabeth Hughes; Steve Parrott; John Strang; Avril Taylor; Judith Watson Journal: Harm Reduct J Date: 2017-03-21
Authors: Alan Yeung; Norah E Palmateer; John F Dillon; Scott A McDonald; Shanley Smith; Stephen Barclay; Peter C Hayes; Rory N Gunson; Kate Templeton; David J Goldberg; Matthew Hickman; Sharon J Hutchinson Journal: J Hepatol Date: 2021-10-09 Impact factor: 25.083