TY - JOUR
T1 - Nonadherence to Ledipasvir/Sofosbuvir Did Not Predict Sustained Virologic Response in a Randomized Controlled Trial of Human Immunodeficiency Virus/Hepatitis C Virus Coinfected Persons Who Use Drugs
AU - Ward, Kathleen M.
AU - Falade-Nwulia, Oluwaseun
AU - Moon, Juhi
AU - Sutcliffe, Catherine G.
AU - Brinkley, Sherilyn
AU - Haselhuhn, Taryn
AU - Katz, Stephanie
AU - Herne, Kayla
AU - Arteaga, Lilian
AU - Mehta, Shruti H.
AU - Latkin, Carl
AU - Brooner, Robert K.
AU - Sulkowski, Mark S.
N1 - Publisher Copyright:
© 2021 The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.
PY - 2022/3/1
Y1 - 2022/3/1
N2 - Background: Eliminating hepatitis C virus (HCV) will require effective treatment delivery to persons with substance use disorders (SUDs). We evaluated the relationship between ledipasvir/sofosbuvir treatment persistence (receiving 84 tablets), adherence, and sustained virologic response (SVR) in persons with human immunodeficiency virus (HIV)/HCV coinfection. Methods: Of the 144 participants with HIV/HCV and SUDs, 110 initiated a 12-week treatment course under 1 of 3 conditions (usual care, peer mentors, and cash incentives). We used self-report, pharmacy pill counts, and expected date of refill to examine adherence. Persistent participants were categorized as high adherence (taking ≥90% of doses) or low adherence (taking <90% of doses). Results: Most participants persisted on treatment after initiation (n = 105), with 95% (n = 100) achieving SVR. One third (34%) of participants had moderate/heavy alcohol use by the biomarker phosphatidylethanol ([Peth] ≥50 ng/mL), and 44% had urine toxicology positive for cocaine or heroin at enrollment. The proportion of persons with high adherence was 72% (n = 76), and the proportion of persons with low adherence was 28%. Although low adherence was associated with moderate/heavy alcohol use by PEth (relative risk = 2.77; 95% confidence interval, 1.50-5.12), SVR did not vary according to adherence (P =. 702), and most participants (97%) with low adherence achieved SVR. Conclusions: Treatment persistence led to high SVR rates among persons with HIV/HCV, despite imperfect adherence and SUDs.
AB - Background: Eliminating hepatitis C virus (HCV) will require effective treatment delivery to persons with substance use disorders (SUDs). We evaluated the relationship between ledipasvir/sofosbuvir treatment persistence (receiving 84 tablets), adherence, and sustained virologic response (SVR) in persons with human immunodeficiency virus (HIV)/HCV coinfection. Methods: Of the 144 participants with HIV/HCV and SUDs, 110 initiated a 12-week treatment course under 1 of 3 conditions (usual care, peer mentors, and cash incentives). We used self-report, pharmacy pill counts, and expected date of refill to examine adherence. Persistent participants were categorized as high adherence (taking ≥90% of doses) or low adherence (taking <90% of doses). Results: Most participants persisted on treatment after initiation (n = 105), with 95% (n = 100) achieving SVR. One third (34%) of participants had moderate/heavy alcohol use by the biomarker phosphatidylethanol ([Peth] ≥50 ng/mL), and 44% had urine toxicology positive for cocaine or heroin at enrollment. The proportion of persons with high adherence was 72% (n = 76), and the proportion of persons with low adherence was 28%. Although low adherence was associated with moderate/heavy alcohol use by PEth (relative risk = 2.77; 95% confidence interval, 1.50-5.12), SVR did not vary according to adherence (P =. 702), and most participants (97%) with low adherence achieved SVR. Conclusions: Treatment persistence led to high SVR rates among persons with HIV/HCV, despite imperfect adherence and SUDs.
KW - adherence
KW - direct-acting antivirals
KW - hepatitis C virus
KW - substance use disorders
KW - sustained virologic response
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U2 - 10.1093/infdis/jiab477
DO - 10.1093/infdis/jiab477
M3 - Article
C2 - 34543417
AN - SCOPUS:85125552918
SN - 0022-1899
VL - 225
SP - 903
EP - 911
JO - Journal of Infectious Diseases
JF - Journal of Infectious Diseases
IS - 5
ER -