Sex Discrepancies in the Protective Effect of Opioid Agonist Therapy on Incident Hepatitis C Infection

International Collaboration of Incident HIV and HCV in Injecting Cohorts (InC3) Collaborative

Research output: Contribution to journalArticle

Abstract

BACKGROUND: While opioid agonist therapy (OAT) reduces the risk of hepatitis C virus (HCV) acquisition among people who inject drugs (PWID), protective effects may be attenuated in females. We used pooled data from an international collaboration of prospective cohorts to assess sex disparities in HCV incidence among PWID exposed to OAT. METHODS: Independent predictors of HCV infection were identified using Cox regression models with random effects after accounting for the clustering effect of study sites. Unadjusted and adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) are presented in sex-specific analyses. RESULTS: Among 701 participants exposed to OAT, HCV incidence was 16.5/100 person-years of observation (PYO) (95% CI, 13.1-20.7) in females and 7.6/100 PYO (95% CI, 6.0-9.5) in males (female:male adjusted HR [aHR], 1.80 [95% CI, 1.37-2.22]; P < .001). Factors associated with HCV acquisition among females exposed to OAT included nonwhite race (aHR, 1.79 [95% CI, 1.25-2.56]; P = .001), unstable housing (aHR, 4.00 [95% CI, 3.62-4.41]; P < .001), daily or more frequent injection (aHR, 1.45 [95% CI, 1.01-2.08]; P = .042), and receptive syringe sharing (aHR, 1.43 [95% CI, 1.33-1.53]; P < .001). CONCLUSIONS: Female PWID exposed to OAT are twice as likely as their male counterparts to acquire HCV. While there is a need for better understanding of sex differences in immune function and opioid pharmacokinetic and pharmacodynamic parameters, structural and behavioral interventions that target women are required to bolster the efficacy of OAT in preventing HCV transmission.

Original languageEnglish (US)
Pages (from-to)123-131
Number of pages9
JournalClinical infectious diseases : an official publication of the Infectious Diseases Society of America
Volume70
Issue number1
DOIs
StatePublished - Jan 1 2020

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Hepatitis C
Opioid Analgesics
Hepacivirus
Confidence Intervals
Infection
Therapeutics
Observation
Needle Sharing
Protective Agents
Incidence
Virus Diseases
Proportional Hazards Models
Sex Characteristics
Pharmaceutical Preparations
Cluster Analysis
Pharmacokinetics
Injections

Keywords

  • harm reduction
  • opioid agonist therapy
  • people who inject drugs
  • sex; hepatitis C virus

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Sex Discrepancies in the Protective Effect of Opioid Agonist Therapy on Incident Hepatitis C Infection. / International Collaboration of Incident HIV and HCV in Injecting Cohorts (InC3) Collaborative.

In: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, Vol. 70, No. 1, 01.01.2020, p. 123-131.

Research output: Contribution to journalArticle

International Collaboration of Incident HIV and HCV in Injecting Cohorts (InC3) Collaborative. / Sex Discrepancies in the Protective Effect of Opioid Agonist Therapy on Incident Hepatitis C Infection. In: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2020 ; Vol. 70, No. 1. pp. 123-131.
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abstract = "BACKGROUND: While opioid agonist therapy (OAT) reduces the risk of hepatitis C virus (HCV) acquisition among people who inject drugs (PWID), protective effects may be attenuated in females. We used pooled data from an international collaboration of prospective cohorts to assess sex disparities in HCV incidence among PWID exposed to OAT. METHODS: Independent predictors of HCV infection were identified using Cox regression models with random effects after accounting for the clustering effect of study sites. Unadjusted and adjusted hazard ratios (HRs) and 95{\%} confidence intervals (CIs) are presented in sex-specific analyses. RESULTS: Among 701 participants exposed to OAT, HCV incidence was 16.5/100 person-years of observation (PYO) (95{\%} CI, 13.1-20.7) in females and 7.6/100 PYO (95{\%} CI, 6.0-9.5) in males (female:male adjusted HR [aHR], 1.80 [95{\%} CI, 1.37-2.22]; P < .001). Factors associated with HCV acquisition among females exposed to OAT included nonwhite race (aHR, 1.79 [95{\%} CI, 1.25-2.56]; P = .001), unstable housing (aHR, 4.00 [95{\%} CI, 3.62-4.41]; P < .001), daily or more frequent injection (aHR, 1.45 [95{\%} CI, 1.01-2.08]; P = .042), and receptive syringe sharing (aHR, 1.43 [95{\%} CI, 1.33-1.53]; P < .001). CONCLUSIONS: Female PWID exposed to OAT are twice as likely as their male counterparts to acquire HCV. While there is a need for better understanding of sex differences in immune function and opioid pharmacokinetic and pharmacodynamic parameters, structural and behavioral interventions that target women are required to bolster the efficacy of OAT in preventing HCV transmission.",
keywords = "harm reduction, opioid agonist therapy, people who inject drugs, sex; hepatitis C virus",
author = "{International Collaboration of Incident HIV and HCV in Injecting Cohorts (InC3) Collaborative} and Louise Geddes and Jenny Iversen and Handan Wand and Aryan Esmaeili and Judith Tsui and Margaret Hellard and Gregory Dore and Jason Grebely and Paul Dietze and Julie Bruneau and Maria Prins and Morris, {Megan D.} and Shoukry, {Naglaa H.} and Lloyd, {Andrew R.} and Kim, {Arthur Y.} and Georg Lauer and Cox, {Andrea L.} and Kimberly Page and Lisa Maher",
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AU - International Collaboration of Incident HIV and HCV in Injecting Cohorts (InC3) Collaborative

AU - Geddes, Louise

AU - Iversen, Jenny

AU - Wand, Handan

AU - Esmaeili, Aryan

AU - Tsui, Judith

AU - Hellard, Margaret

AU - Dore, Gregory

AU - Grebely, Jason

AU - Dietze, Paul

AU - Bruneau, Julie

AU - Prins, Maria

AU - Morris, Megan D.

AU - Shoukry, Naglaa H.

AU - Lloyd, Andrew R.

AU - Kim, Arthur Y.

AU - Lauer, Georg

AU - Cox, Andrea L.

AU - Page, Kimberly

AU - Maher, Lisa

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N2 - BACKGROUND: While opioid agonist therapy (OAT) reduces the risk of hepatitis C virus (HCV) acquisition among people who inject drugs (PWID), protective effects may be attenuated in females. We used pooled data from an international collaboration of prospective cohorts to assess sex disparities in HCV incidence among PWID exposed to OAT. METHODS: Independent predictors of HCV infection were identified using Cox regression models with random effects after accounting for the clustering effect of study sites. Unadjusted and adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) are presented in sex-specific analyses. RESULTS: Among 701 participants exposed to OAT, HCV incidence was 16.5/100 person-years of observation (PYO) (95% CI, 13.1-20.7) in females and 7.6/100 PYO (95% CI, 6.0-9.5) in males (female:male adjusted HR [aHR], 1.80 [95% CI, 1.37-2.22]; P < .001). Factors associated with HCV acquisition among females exposed to OAT included nonwhite race (aHR, 1.79 [95% CI, 1.25-2.56]; P = .001), unstable housing (aHR, 4.00 [95% CI, 3.62-4.41]; P < .001), daily or more frequent injection (aHR, 1.45 [95% CI, 1.01-2.08]; P = .042), and receptive syringe sharing (aHR, 1.43 [95% CI, 1.33-1.53]; P < .001). CONCLUSIONS: Female PWID exposed to OAT are twice as likely as their male counterparts to acquire HCV. While there is a need for better understanding of sex differences in immune function and opioid pharmacokinetic and pharmacodynamic parameters, structural and behavioral interventions that target women are required to bolster the efficacy of OAT in preventing HCV transmission.

AB - BACKGROUND: While opioid agonist therapy (OAT) reduces the risk of hepatitis C virus (HCV) acquisition among people who inject drugs (PWID), protective effects may be attenuated in females. We used pooled data from an international collaboration of prospective cohorts to assess sex disparities in HCV incidence among PWID exposed to OAT. METHODS: Independent predictors of HCV infection were identified using Cox regression models with random effects after accounting for the clustering effect of study sites. Unadjusted and adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) are presented in sex-specific analyses. RESULTS: Among 701 participants exposed to OAT, HCV incidence was 16.5/100 person-years of observation (PYO) (95% CI, 13.1-20.7) in females and 7.6/100 PYO (95% CI, 6.0-9.5) in males (female:male adjusted HR [aHR], 1.80 [95% CI, 1.37-2.22]; P < .001). Factors associated with HCV acquisition among females exposed to OAT included nonwhite race (aHR, 1.79 [95% CI, 1.25-2.56]; P = .001), unstable housing (aHR, 4.00 [95% CI, 3.62-4.41]; P < .001), daily or more frequent injection (aHR, 1.45 [95% CI, 1.01-2.08]; P = .042), and receptive syringe sharing (aHR, 1.43 [95% CI, 1.33-1.53]; P < .001). CONCLUSIONS: Female PWID exposed to OAT are twice as likely as their male counterparts to acquire HCV. While there is a need for better understanding of sex differences in immune function and opioid pharmacokinetic and pharmacodynamic parameters, structural and behavioral interventions that target women are required to bolster the efficacy of OAT in preventing HCV transmission.

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KW - opioid agonist therapy

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KW - sex; hepatitis C virus

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