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- Title
Nonadherence to Ledipasvir/Sofosbuvir Did Not Predict Sustained Virologic Response in a Randomized Controlled Trial of Human Immunodeficiency Virus/Hepatitis C Virus Coinfected Persons Who Use Drugs.
- Authors
Ward, Kathleen M; Falade-Nwulia, Oluwaseun; Moon, Juhi; Sutcliffe, Catherine G; Brinkley, Sherilyn; Haselhuhn, Taryn; Katz, Stephanie; Herne, Kayla; Arteaga, Lilian; Mehta, Shruti H; Latkin, Carl; Brooner, Robert K; Sulkowski, Mark S
- Abstract
<bold>Background: </bold>Eliminating hepatitis C virus (HCV) will require effective treatment delivery to persons with substance use disorders (SUDs). We evaluated the relationship between ledipasvir/sofosbuvir treatment persistence (receiving 84 tablets), adherence, and sustained virologic response (SVR) in persons with human immunodeficiency virus (HIV)/HCV coinfection.<bold>Methods: </bold>Of the 144 participants with HIV/HCV and SUDs, 110 initiated a 12-week treatment course under 1 of 3 conditions (usual care, peer mentors, and cash incentives). We used self-report, pharmacy pill counts, and expected date of refill to examine adherence. Persistent participants were categorized as high adherence (taking ≥90% of doses) or low adherence (taking <90% of doses).<bold>Results: </bold>Most participants persisted on treatment after initiation (n = 105), with 95% (n = 100) achieving SVR. One third (34%) of participants had moderate/heavy alcohol use by the biomarker phosphatidylethanol ([Peth] ≥50 ng/mL), and 44% had urine toxicology positive for cocaine or heroin at enrollment. The proportion of persons with high adherence was 72% (n = 76), and the proportion of persons with low adherence was 28%. Although low adherence was associated with moderate/heavy alcohol use by PEth (relative risk = 2.77; 95% confidence interval, 1.50-5.12), SVR did not vary according to adherence (P = .702), and most participants (97%) with low adherence achieved SVR.<bold>Conclusions: </bold>Treatment persistence led to high SVR rates among persons with HIV/HCV, despite imperfect adherence and SUDs.
- Subjects
HEPATITIS C virus; HIV; RANDOMIZED controlled trials; RANDOMIZED response; SOFOSBUVIR; HIV infection complications; HIV infections; RESEARCH; SUBSTANCE abuse; CHRONIC hepatitis C; HETEROCYCLIC compounds; RESEARCH methodology; HEPATITIS C; HEPATITIS viruses; ANTIVIRAL agents; EVALUATION research; TREATMENT effectiveness; HYDROCARBONS; COMPARATIVE studies; MIXED infections; DRUGS; RESEARCH funding; STATISTICAL sampling; PHARMACODYNAMICS; DISEASE complications
- Publication
Journal of Infectious Diseases, 2022, Vol 225, Issue 5, p903
- ISSN
0022-1899
- Publication type
journal article
- DOI
10.1093/infdis/jiab477