Sex Discrepancies in the Protective Effect of Opioid Agonist Therapy on Incident Hepatitis C Infection.

Analgesics, Opioid / therapeutic use Female Hepacivirus Hepatitis C / epidemiology Humans Male Prospective Studies Substance Abuse, Intravenous / complications
harm reduction opioid agonist therapy people who inject drugs sex; hepatitis C virus

Journal

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
ISSN: 1537-6591
Titre abrégé: Clin Infect Dis
Pays: United States
ID NLM: 9203213

Informations de publication

Date de publication:
01 01 2020
Historique:
received: 08 10 2018
accepted: 22 02 2019
pubmed: 1 3 2019
medline: 7 1 2021
entrez: 1 3 2019
Statut: ppublish

Résumé

While opioid agonist therapy (OAT) reduces the risk of hepatitis C virus (HCV) acquisition among people who inject drugs (PWID), protective effects may be attenuated in females. We used pooled data from an international collaboration of prospective cohorts to assess sex disparities in HCV incidence among PWID exposed to OAT. Independent predictors of HCV infection were identified using Cox regression models with random effects after accounting for the clustering effect of study sites. Unadjusted and adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) are presented in sex-specific analyses. Among 701 participants exposed to OAT, HCV incidence was 16.5/100 person-years of observation (PYO) (95% CI, 13.1-20.7) in females and 7.6/100 PYO (95% CI, 6.0-9.5) in males (female:male adjusted HR [aHR], 1.80 [95% CI, 1.37-2.22]; P < .001). Factors associated with HCV acquisition among females exposed to OAT included nonwhite race (aHR, 1.79 [95% CI, 1.25-2.56]; P = .001), unstable housing (aHR, 4.00 [95% CI, 3.62-4.41]; P < .001), daily or more frequent injection (aHR, 1.45 [95% CI, 1.01-2.08]; P = .042), and receptive syringe sharing (aHR, 1.43 [95% CI, 1.33-1.53]; P < .001). 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 behavioral interventions that target women are required to bolster the efficacy of OAT in preventing HCV transmission.

Sections du résumé

BACKGROUND
While opioid agonist therapy (OAT) reduces the risk of hepatitis C virus (HCV) acquisition among people who inject drugs (PWID), protective effects may be attenuated in females. We used pooled data from an international collaboration of prospective cohorts to assess sex disparities in HCV incidence among PWID exposed to OAT.
METHODS
Independent predictors of HCV infection were identified using Cox regression models with random effects after accounting for the clustering effect of study sites. Unadjusted and adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) are presented in sex-specific analyses.
RESULTS
Among 701 participants exposed to OAT, HCV incidence was 16.5/100 person-years of observation (PYO) (95% CI, 13.1-20.7) in females and 7.6/100 PYO (95% CI, 6.0-9.5) in males (female:male adjusted HR [aHR], 1.80 [95% CI, 1.37-2.22]; P < .001). Factors associated with HCV acquisition among females exposed to OAT included nonwhite race (aHR, 1.79 [95% CI, 1.25-2.56]; P = .001), unstable housing (aHR, 4.00 [95% CI, 3.62-4.41]; P < .001), daily or more frequent injection (aHR, 1.45 [95% CI, 1.01-2.08]; P = .042), and receptive syringe sharing (aHR, 1.43 [95% CI, 1.33-1.53]; P < .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 behavioral interventions that target women are required to bolster the efficacy of OAT in preventing HCV transmission.

Identifiants

DOI: 10.1093/cid/ciz162 PMID: 30816419 PMC: PMC6912156
pubmed: 30816419
pii: 5366653
doi: 10.1093/cid/ciz162
pmc: PMC6912156
doi:

Substances chimiques

Analgesics, Opioid 0

Types de publication

Journal Article Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

123-131

Subventions

Organisme : NIAID NIH HHS
ID : U19 AI066345
Pays : United States
Organisme : CIHR
ID : MOP-19106468
Pays : Canada
Organisme : NIGMS NIH HHS
ID : U54 GM104944
Pays : United States
Organisme : NIAID NIH HHS
ID : U19 AI088791
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR001449
Pays : United States
Organisme : NIDA NIH HHS
ID : R01 DA031056
Pays : United States
Organisme : NIDA NIH HHS
ID : R01 DA016017
Pays : United States
Organisme : CIHR
ID : MOP-103138
Pays : Canada

Informations de copyright

© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

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Auteurs

Louise Geddes (L)

Kirby Institute, University of New South Wales Sydney, Australia.

Jenny Iversen (J)

Kirby Institute, University of New South Wales Sydney, Australia.

Handan Wand (H)

Kirby Institute, University of New South Wales Sydney, Australia.

Aryan Esmaeili (A)

Clinical Research Education, Icahn School of Medicine at Mount Sinai, New York.

Judith Tsui (J)

University of Washington School of Medicine, Seattle.

Margaret Hellard (M)

Burnet Institute, Melbourne, Victoria, Australia.

Gregory Dore (G)

Kirby Institute, University of New South Wales Sydney, Australia.

Jason Grebely (J)

Kirby Institute, University of New South Wales Sydney, Australia.

Paul Dietze (P)

Burnet Institute, Melbourne, Victoria, Australia.

Julie Bruneau (J)

Le Centre de recherche du Centre Hospitalier de l'Université de Montréal, Université de Montréal, Quebec, Canada.

Maria Prins (M)

Cluster Infectious Diseases, Public Health Service of Amsterdam, The Netherlands.
Amsterdam University Medical Center, University of Amsterdam, Department of Infectious Diseases, Amsterdam Infection and Immunity Institute, The Netherlands.

Megan D Morris (MD)

University of California, San Francisco.

Naglaa H Shoukry (NH)

Le Centre de recherche du Centre Hospitalier de l'Université de Montréal, Université de Montréal, Quebec, Canada.

Andrew R Lloyd (AR)

Kirby Institute, University of New South Wales Sydney, Australia.

Arthur Y Kim (AY)

Harvard Medical School, Boston, Massachusetts.

Georg Lauer (G)

Harvard Medical School, Boston, Massachusetts.

Andrea L Cox (AL)

Department of Medicine, Johns Hopkins University, Baltimore, Maryland.

Kimberly Page (K)

University of New Mexico Health Sciences Center, Albuquerque.

Lisa Maher (L)

Kirby Institute, University of New South Wales Sydney, Australia.

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Classifications MeSH

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