Andreea A Artenie1, Nanor Minoyan1, Brendan Jacka1, Stine Høj1, Didier Jutras-Aswad1, Élise Roy1, Lise Gauvin1, Geng Zang1, Julie Bruneau2. 1. Department of Social and Preventive Medicine (Artenie, Minoyan, Gauvin), School of Public Health, Université de Montréal; Research Centre (Artenie, Minoyan, Jacka, Høj, Jutras-Aswad, Gauvin, Zang, Bruneau), Centre Hospitalier de l'Université de Montréal; Department of Psychiatry (Jutras-Aswad), Université de Montréal, Montréal, Que.; Addiction Studies and Research Program (Roy), Université de Sherbrooke, Longueuil, Que.; Institut national de santé publique du Québec (Roy); Department of Family and Emergency Medicine (Bruneau), Université de Montréal, Montréal, Que. 2. Department of Social and Preventive Medicine (Artenie, Minoyan, Gauvin), School of Public Health, Université de Montréal; Research Centre (Artenie, Minoyan, Jacka, Høj, Jutras-Aswad, Gauvin, Zang, Bruneau), Centre Hospitalier de l'Université de Montréal; Department of Psychiatry (Jutras-Aswad), Université de Montréal, Montréal, Que.; Addiction Studies and Research Program (Roy), Université de Sherbrooke, Longueuil, Que.; Institut national de santé publique du Québec (Roy); Department of Family and Emergency Medicine (Bruneau), Université de Montréal, Montréal, Que. julie.bruneau@umontreal.ca.
Abstract
BACKGROUND: Opioid agonist treatment is considered important in preventing acquisition of hepatitis C virus (HCV) among people who inject drugs; however, the role of dosage in opioid agonist treatment is unclear. We investigated the joint association of prescribed dosage of opioid agonist treatment and patient-perceived dosage adequacy with risk of HCV infection among people who inject drugs. METHODS: We followed prospectively people who inject drugs at risk of acquiring HCV infection (who were RNA negative and HCV-antibody negative or positive) in Montréal, Canada (2004-2017). At 6-month, then 3-month intervals, participants were tested for HCV antibodies or RNA, and completed an interviewer-administered behavioural questionnaire, reporting the following: current exposure to opioid agonist treatment (yes/no), prescribed dosage either high (methadone ≥ 60 mg/d or buprenorphine ≥ 16 mg/d) or low, and perceived dosage adequacy (adequate/inadequate). We then assigned participants to 1 of 5 exposure categories: no opioid agonist treatment, high dosage of opioid agonist treatment perceived to be adequate, high dosage perceived to be inadequate, low dosage perceived to be adequate or low dosage perceived to be inadequate. To estimate associations between categories of opioid agonist treatment dosage and incident HCV infection, we conducted Cox regression analyses, adjusting for multiple confounding factors. RESULTS: Of 513 participants (median age 35.0 yr, 77.6% male), 168 acquired HCV over 1422.6 person-years of follow-up (incidence 11.8/100 person-years, 95% confidence interval [CI] 10.1-13.7). We observed a gradient in the relative risks of HCV infection across categories of opioid agonist treatment dosage. Compared with people who inject drugs not receiving opioid agonist treatment, adjusted hazard ratios were 0.43 (95% CI 0.23-0.84) for those receiving high dosages perceived to be adequate, 0.61 (95% CI 0.25-1.50) for those receiving high dosages perceived to be inadequate, 1.22 (95% CI 0.74-2.00) for those receiving low dosages perceived to be adequate and 1.94 (95% CI 1.11-3.39) for those receiving low dosages perceived to be inadequate. INTERPRETATION: Risk of HCV infection varies considerably according to dosage of opioid agonist treatment and patient-perceived adequacy, with associations indicating both protective and harmful effects relative to no exposure to opioid agonist treatment.
BACKGROUND: Opioid agonist treatment is considered important in preventing acquisition of hepatitis C virus (HCV) among people who inject drugs; however, the role of dosage in opioid agonist treatment is unclear. We investigated the joint association of prescribed dosage of opioid agonist treatment and patient-perceived dosage adequacy with risk of HCV infection among people who inject drugs. METHODS: We followed prospectively people who inject drugs at risk of acquiring HCV infection (who were RNA negative and HCV-antibody negative or positive) in Montréal, Canada (2004-2017). At 6-month, then 3-month intervals, participants were tested for HCV antibodies or RNA, and completed an interviewer-administered behavioural questionnaire, reporting the following: current exposure to opioid agonist treatment (yes/no), prescribed dosage either high (methadone ≥ 60 mg/d or buprenorphine ≥ 16 mg/d) or low, and perceived dosage adequacy (adequate/inadequate). We then assigned participants to 1 of 5 exposure categories: no opioid agonist treatment, high dosage of opioid agonist treatment perceived to be adequate, high dosage perceived to be inadequate, low dosage perceived to be adequate or low dosage perceived to be inadequate. To estimate associations between categories of opioid agonist treatment dosage and incident HCV infection, we conducted Cox regression analyses, adjusting for multiple confounding factors. RESULTS: Of 513 participants (median age 35.0 yr, 77.6% male), 168 acquired HCV over 1422.6 person-years of follow-up (incidence 11.8/100 person-years, 95% confidence interval [CI] 10.1-13.7). We observed a gradient in the relative risks of HCV infection across categories of opioid agonist treatment dosage. Compared with people who inject drugs not receiving opioid agonist treatment, adjusted hazard ratios were 0.43 (95% CI 0.23-0.84) for those receiving high dosages perceived to be adequate, 0.61 (95% CI 0.25-1.50) for those receiving high dosages perceived to be inadequate, 1.22 (95% CI 0.74-2.00) for those receiving low dosages perceived to be adequate and 1.94 (95% CI 1.11-3.39) for those receiving low dosages perceived to be inadequate. INTERPRETATION: Risk of HCV infection varies considerably according to dosage of opioid agonist treatment and patient-perceived adequacy, with associations indicating both protective and harmful effects relative to no exposure to opioid agonist treatment.
Authors: Chiedozie Arum; Hannah Fraser; Andreea Adelina Artenie; Sandra Bivegete; Adam Trickey; Michel Alary; Jacquie Astemborski; Jennifer Iversen; Aaron G Lim; Louis MacGregor; Meghan Morris; Jason J Ong; Lucy Platt; Rachel Sack-Davis; Daniela K van Santen; Sunil S Solomon; Vana Sypsa; Jorge Valencia; Wijnand Van Den Boom; Josephine G Walker; Zoe Ward; Jack Stone; Peter Vickerman Journal: Lancet Public Health Date: 2021-03-26
Authors: Daniel L Brook; Angela T Hetrick; Shibani R Chettri; Christine A Schalkoff; Adams L Sibley; Kathryn E Lancaster; Vivian F Go; William C Miller; David M Kline Journal: Open Forum Infect Dis Date: 2021-05-17 Impact factor: 3.835