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Clinical Trial
. 2011 Jul;55(1):76-85.
doi: 10.1016/j.jhep.2010.10.033. Epub 2010 Nov 23.

Adherence to treatment for recently acquired hepatitis C virus (HCV) infection among injecting drug users

Jason Grebely  1 , Gail V Matthews, Margaret Hellard, David Shaw, Ingrid van Beek, Kathy Petoumenos, Maryam Alavi, Barbara Yeung, Paul S Haber, Andrew R Lloyd, John M Kaldor, Gregory J Dore; ATAHC Study Group
Collaborators, Affiliations
Clinical Trial

Adherence to treatment for recently acquired hepatitis C virus (HCV) infection among injecting drug users

Jason Grebely et al. J Hepatol. 2011 Jul.

Abstract

Background & aims: Adherence to HCV therapy impacts sustained virological response (SVR) but there are limited data on adherence, particularly among injecting drug users (IDUs). We assessed 80/80 adherence (≥80% of PEG-IFN doses, ≥80% treatment), on-treatment adherence, and treatment completion in a study of treatment of recent HCV infection (ATAHC).

Methods: Participants with HCV received pegylated interferon (PEG-IFN) alfa-2a (180μg/week, n=74) and those with HCV/HIV received PEG-IFN alfa-2a with ribavirin (n=35), for a planned 24 weeks. Logistic regression analyses were used to identify predictors of PEG-IFN 80/80 adherence.

Results: A total of 109 out of 163 patients received treatment (HCV, n=74; HCV/HIV, n=35), with 75% ever reporting IDU. The proportion with 80/80 PEG-IFN adherence was 82% (n=89). During treatment, 14% missed ≥1 dose (on-treatment adherence=99%). Completion of 0-4, 5-19, 20-23, and all 24 weeks of PEG-IFN therapy occurred in 10% (n=11), 14% (n=15), 6% (n=7) and 70% (n=76) of cases, respectively. Participants with no tertiary education were less likely to have 80/80 PEG-IFN adherence (AOR 0.29, p=0.045). IDU prior to or during treatment did not impact 80/80 PEG-IFN adherence. SVR was higher among those patients with ≥80/80 PEG-IFN adherence (67% vs. 35%, p=0.007), but similar among those with and without missed doses during therapy (73% vs. 60%, p=0.309). SVR in those patients discontinuing therapy between 0-4, 5-19, 20-23, and 24 weeks was 9%, 33%, 43%, and 76%, respectively (p<0.001).

Conclusions: High adherence to treatment for recent HCV was observed, irrespective of IDU prior to, or during, therapy. Sub-optimal PEG-IFN exposure was mainly driven by early treatment discontinuation rather than missed doses during therapy.

Trial registration: ClinicalTrials.gov NCT00192569.

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Figures

Figure 1
Figure 1
PEG-IFN adherence among participants with A) HCV receiving PEG-IFN alone in the ATAHC study (n=74). B) HCV/HIV receiving PEG-IFN and ribavirin in the ATAHC study (n=35). Black boxes represent dose received, grey boxes - dose-reductions and blank boxes - no dose received. SVR, sustained virologic response; Y, yes; N, no.
Figure 1
Figure 1
PEG-IFN adherence among participants with A) HCV receiving PEG-IFN alone in the ATAHC study (n=74). B) HCV/HIV receiving PEG-IFN and ribavirin in the ATAHC study (n=35). Black boxes represent dose received, grey boxes - dose-reductions and blank boxes - no dose received. SVR, sustained virologic response; Y, yes; N, no.
Figure 2
Figure 2
Time to treatment discontinuation among treated participants in the ATAHC study (n=109)
See this image and copyright information in PMC

References

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