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BMC Infect Dis. 2017 Jun 13;17(1):420. doi: 10.1186/s12879-017-2517-3.

Adherence to response-guided pegylated interferon and ribavirin for people who inject drugs with hepatitis C virus genotype 2/3 infection: the ACTIVATE study.

Author information

1
The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia. ecunningham@Kirby.Unsw.Edu.Au.
2
The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.
3
Akershus University Hospital, Oslo, Norway.
4
Burnet Institute, Melbourne, VIC, Australia.
5
The Liver Unit, Queen Mary University of London, London, UK.
6
Arud Centres for Addiction Medicine, Zurich, Switzerland.
7
Vancouver Infectious Diseases Center, Vancouver, BC, Canada.
8
Ludwig Maximilians-University Munich, Munich, Germany.
9
Department of Gastroenterology and Hepatology, Ziekenhuis Oost Limburg, Genk, Belgium.
10
Department of Hepatology, UZ Leuven, Leuven, Belgium.
11
UHasselt, Hasselt, Belgium.
12
Treatment Action Group, New York, NY, USA.
13
Nepean Hospital, Sydney, NSW, Australia.
14
Royal Adelaide Hospital, Adelaide, South Australia, Australia.
15
School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia.
16
Research Center, Centre Hospitalier de l'Universite de Montreal (CRCHUM), Montreal, Quebec, Canada.
17
Stuivenberg ZNA, Antwerp, Belgium.
18
Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland.

Abstract

BACKGROUND:

The aims of this analysis were to investigate treatment completion and adherence among people with ongoing injecting drug use or receiving opioid substitution therapy (OST) in a study of response-guided therapy for chronic HCV genotypes 2/3 infection.

METHODS:

ACTIVATE was a multicenter clinical trial recruited between 2012 and 2014. Participants with genotypes 2/3 were treated with directly observed peg-interferon alfa-2b (PEG-IFN) and self-administered ribavirin for 12 (undetectable HCV RNA at week 4) or 24 weeks (detectable HCV RNA at week 4). Outcomes included treatment completion, PEG-IFN adherence, ribavirin adherence, and sustained virological response (SVR, undetectable HCV RNA >12 weeks post-treatment).

RESULTS:

Among 93 people treated, 59% had recently injected drugs (past month), 77% were receiving OST and 56% injected drugs during therapy. Overall, 76% completed treatment. Mean on-treatment adherence to PEG-IFN and ribavirin were 98.2% and 94.6%. Overall, 6% of participants missed >1 dose of PEG-IFN and 31% took <95% of their prescribed ribavirin., Higher treatment completion was observed among those receiving 12 vs. 24 weeks of treatment (97% vs. 46%, P < 0.001) while the proportion of participants with 95% on-treatment ribavirin adherence was similar between groups (67% vs. 72%, P = 0.664). Receiving 12 weeks of therapy was independently associated with treatment completion. No factors were associated with 95% RBV adherence. Neither recent injecting drug use at baseline nor during therapy was associated with treatment completion or adherence to ribavirin. In adjusted analysis, treatment completion was associated with SVR (aOR 23.9, 95% CI 2.9-193.8).

CONCLUSIONS:

This study demonstrated a high adherence to directly observed PEG-IFN and self-administered ribavirin among people with ongoing injecting drug use or receiving OST. These data also suggest that shortening therapy from 24 to 12 weeks can lead to improved treatment completion. Treatment completion was associated with improved response to therapy. ACTIVATE trial registration number: NCT01364090 - May 31, 2011.

KEYWORDS:

Adherence; Hepatitis C; Injection drug use; PWID; Treatment

PMID:
28610605
PMCID:
PMC5470219
DOI:
10.1186/s12879-017-2517-3
[Indexed for MEDLINE]
Free PMC Article

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