AASLD 2014: Young Drug Injectors on Opioid Agonist Therapy Have Lower Risk of HCV Infection


Young people who inject drugs (PWID) who undergo opioid agonist maintenance therapy with methadone or buprenorphine have more than a 60% reduction in their risk of acquiring hepatitis C virus (HCV) over time, compared to those with no substance use treatment, according to a study presented Monday at the American Association for the Study of Liver Diseases (AASLD) Liver Meeting in Boston. Findings were also published in the October 27 edition of JAMA Internal Medicine.

HCV is readily transmitted through contact with blood, which can occur when people share syringes and other equipment for injecting drugs. In most developed countries, shared injection equipment is the major route of HCV transmission.

Substitution or maintenance therapy using opioid agonists like methadone or buprenorphine have been shown to be effective in treating addiction to opiates such as heroin. Opioid agonists, which use the same brain receptors as opiates, can prevent withdrawal symptoms but typically do not produce a "high" at the doses used for maintenance therapy. By enabling people to use injected drugs less often or not at all, maintenance therapy may help reduce exposure to HCV.

Kimberly Page from the University of New Mexico Health Sciences Center, Judith Tsui from Boston University School of Medicine, and colleagues evaluated whether opioid agonist therapy was associated with a lower incidence of HCV infection among young adult drug injectors, who are vulnerable to infection soon after they start injecting.

The UFO Study is a prospective, observational cohort study of young (under age 30) active injection drug users in San Francisco. Participants were enrolled in 3 waves (January 2000, February 2003, and May 2010) and followed through August 2013.

Follow-up interviews and blood testing for HCV were performed quarterly. Incident or new HCV infection was defined as a new positive HCV antibody or HCV RNA test result following a previous documented negative test, or a positive HCV RNA test coinciding with a negative antibody test, which indicates acute or recent infection.

The study compared people who underwent various types of substance use treatment within the past 3 months: opioid agonist maintenance therapy, opioid agonist detoxification without ongoing maintenance, non-opioid agonist forms of treatment (such as 12-step programs or counselling), or no treatment.

This analysis included 552 young PWID (out of 1548 initially screened) who had injected drugs within the past 30 daysand who tested negative for HCV at study entry. A majority were men and 73% were white. The median age was 23 years and they had been injecting for a median of 3.6 years. More than two-thirds had been homeless in the past 3 months and about one-quarter were recently incarcerated. The most commonly used drug was heroin, reported by 60%, and one-third said they injected daily. Most participants (82%) reported no substance use treatment during the prior year.


As a limitation, the researchers noted that since the majority of study participants were not using substance use treatment, the comparisons across treatment types involved small numbers. There were not enough people to compare methadone versus buprenorphine.

Nevertheless, the 61% risk reduction seen in this study falls within the range seen in other studies of opioid agonist therapy, such as a 53% reduction in Vancouver and a 82% reduction in Sydney.

"In this study of young adult injectors, we found that maintenance opioid agonist therapy(methadone or buprenorphine) for opioid use disorders was associated with more than a 60% reduction in HCV incidence over time compared to no treatment," the researchers concluded.

"Our results suggest that treatment for opioid use disorders with maintenance opioid agonist therapycan reduce acquisition of HCV in young adult injectors, and should be offered as an important component of comprehensive strategies for primary HCV prevention," they added.



JI Tsui, J Evans, PJ Lum, K Page, et al. Opioid Agonist Therapy is Associated with Lower Incidence of Hepatitis C Virus Infection in Young Adult Persons Who Inject Drugs. American Association for the Study of Liver Diseases (AASLD) Liver Meeting. Boston, November 7-11, 2014. Abstract 171.