Journal Article Annotations
2019, 2nd Quarter
Annotations by Aum A. Pathare, M.D.
July 2019
Findings:
Exposure to a low dose of methadone or buprenorphine, if perceived to be inadequate by patients, was observed to increase the risk of HCV infection twofold compared to no opioid agonist treatment. Use of high dosage of opioid agonist treatment, that was perceived to be adequate, was associated with a 60 % lower risk of infection. A low dose that was perceived to be adequate, and a high dose perceived as inadequate, were not significantly different compared to no treatment with opioid agonists.
Strengths and limitations:
HIV infected individuals were excluded from the HEPCO sample, and the participants were not randomly selected, reducing the study’s generalizability. The potential for residual confounding, and losses to follow up leading to bias are potential pitfalls of this study, along with misclassification of agonist dosage due to the self-report. However, the authors note good follow-up rates, and the similarity of baseline characteristics in those lost to the study compared to those retained.
Relevance:
Treatment of opioid use has a become a priority, and is often a secondary goal for other initiatives, such as prevention of HCV infection. This study shows that the risk of HCV infection in patients with injection drug use is not just contingent on the prescribed dose, but also the patients’ perception about the adequacy of this dose. The best outcomes were seen in people who were prescribed a higher dose of medications that was also perceived to be adequate. Programs that are seeking to expand access, or evaluate patients for other issues, such as transplants, need to be aware of how the risk to these patients is modified. The limitations to HCV prevention by opioid agonist treatment alone should be discussed with patients and other stakeholders.
Type of study:
Prospective cohort study