Concurrent Initiation of Hepatitis C and Opioid Use Disorder Treatment in People Who Inject Drugs.

BACKGROUND: People who inject drugs have high prevalence of hepatitis C virus (HCV) and significant morbidity associated with drug use, however HCV treatment often occurs in absence of interventions to address opioid use disorder (OUD) and drug use related harms. The impact of concurrent initiation of opioid agonist therapy (OAT) on HCV treatment and drug-use outcomes is unknown. METHODS: In this prospective, open-label, observational trial (NCT03221309) at a harm reduction organization drop-in center in Washington, DC, 100 patients with chronic HCV, OUD, and ongoing injection drug-use were treated with sofosbuvir/velpatasvir for 12-weeks and offered buprenorphine initiation. The primary end point was sustained virologic response (SVR), and secondary end points included uptake of and retention in OAT, change in risk behavior, and determinants of SVR. RESULTS: Eighty-two patients (82%) achieved SVR, which was not associated with baseline OAT status (p=0.33), on-treatment drug-use (p=1.00), or imperfect daily adherence (p=0.35), but was significantly associated with completing two or more bottles of sofosbuvir/velpatasvir (p=0.0001) and being on OAT at week 24 (p=0.01). Of sixty-seven patients not on baseline OAT, fifty-three (79%) initiated OAT. At week 24, sixty-eight (68%) patients were on OAT. Being on OAT was associated with fewer opiate-positive urine drug screens (p=0.003), lower HIV risk-taking behavior scores (p<0.0001), and lower rates of opioid overdose (p=0.04). CONCLUSIONS: The ANCHOR study demonstrates high uptake of buprenorphine collocated with HCV treatment, and shows that concurrent initiation of OAT with HCV treatment can result in high rates of SVR while reducing risks associated with drug use.