Opioid Agonist Treatment Is Associated with a Lower Incidence of Hepatitis C Infection Among People with Injection Drug Use

Injection drug use (IDU) is the primary risk factor for hepatitis C virus (HCV) infection. Researchers examined data from a cohort of 552 younger adults (< 30 years) with IDU who were not HCV infected at the time of enrollment. The outcome of interest was incident HCV infection. Recruitment began in 2000 and the final assessment was in 2013, with a total of 680 person-years of observation.

• At the time of enrollment, participants’ median age was 23; 68% were men, 40% did not graduate from high school, and 69% were homeless or did not have stable housing in the last 3 months. The median duration of IDU was 3.6 years and 33% of participants had daily use; 60% reported that heroin was the drug they used most often. Most (82%) reported receiving no substance use treatment in the prior year and only 4% had received opioid agonist treatment (OAT).
• There were a total of 171 incident HCV infections, with an estimated incidence rate of 25 per 100 person-years.
• Participants who reported receiving OAT in the past year had a significantly lower incidence of HCV (rate ratio [RR], 0.31), while those who reported other forms of treatment did not. The RR for non-opioid agonist treatment was 0.63, and for opioid agonist detoxification it was 1.45.

Comments:

This study shows that HCV is still a common hazard for people with IDU and confirms prior observations that OAT reduces the risk of acquiring this deadly infection. Unfortunately very few of the participants received methadone or buprenorphine maintenance treatment; we need to do more to improve access.

Darius A. Rastegar, MD

Reference:

Tsui JI, Evans JL, Lum PJ, et al. Association of opioid agonist therapy with lower incidence of hepatitis C virus infection in young adult injection drug users. JAMA Intern Med. 2014;174:1974–1981.