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Clin Infect Dis. 2019 Feb 28. pii: ciz162. doi: 10.1093/cid/ciz162. [Epub ahead of print]

Sex discrepancies in the protective effect of opioid agonist therapy on incident hepatitis C infection.

Author information

1
The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.
2
Clinical Research Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
3
University of Washington School of Medicine, Seattle, WA, USA.
4
Burnet Institute, Melbourne, VIC, Australia.
5
CRCHUM, Université de Montréal, Montréal, QC, CA.
6
Cluster Infectious Diseases, GGD Public Health Service of Amsterdam, Amsterdam, The Netherlands.
7
Amsterdam UMC, University of Amsterdam, Department of Infectious Diseases, Amsterdam Infection & Immunity Institute (AIII), Amsterdam, the Netherlands.
8
University of California San Francisco, San Francisco, CA, USA.
9
Harvard Medical School, Boston, MA, USA.
10
Department of Medicine, Johns Hopkins University, Baltimore, MD, USA.
11
University of New Mexico Health Sciences Center, Albuquerque, NM, USA.

Abstract

BACKGROUND:

While opioid agonist therapy (OAT) reduces the risk of HCV acquisition among people who inject drugs (PWID), protective effects may be attenuated in females compared to males. This study assessed sex disparities in HCV incidence among PWID exposed to OAT and factors independently associated with decreased protective efficacy.

METHODS:

Inc3 pools biological and behavioural data from prospective observational studies examining incident HIV and HCV. Independent predictors were identified using Cox regression models with random effects after accounting for the clustering effect of study sites. Unadjusted and adjusted hazard ratios (aHR) and 95% Confidence Intervals are presented in sex-specific analyses.

RESULTS:

Among 701 participants exposed to OAT observed over 3,003 visits and 1,427 person-years observation (PYO), HCV incidence was 16.5 PYO (95%CI 13.1-20.7) in females and 7.6 PYO (95%CI 6.0-9.5) in males (F:M aHR 1.80, 95%CI 1.37-2.22, p<0.001). Factors associated with HCV acquisition among females exposed to OAT included non-white race (aHR 1.79, 95%CI 1.25-2.56, p=0.001), recent unstable housing (aHR 4.00, 95%CI 3.62-4.41, p<0.001), recent daily or more frequent injection (aHR 1.45, 95%CI 1.01-2.08, p=0.042) and recent receptive syringe sharing (aHR 1.43, 95%CI 1.33-1.53, p<0.001).

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 behavioural interventions that target women, including affordable housing and safe injection self-efficacy, are required to bolster the efficacy of OAT in preventing HCV transmission.

KEYWORDS:

Sex; harm reduction; hepatitis C virus (HCV); opioid agonist therapy; people who inject drugs

PMID:
30816419
DOI:
10.1093/cid/ciz162

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