Changes in Risk Behaviours during and Following Treatment for Hepatitis C Virus Infection among People Who Inject Drugs: The ACTIVATE Study

Author: Håvard Midgard, Behzad Hajarizadeh, Evan Cunningham, Brian Conway, Markus Backmund, Geert Robaeys, Martin Weltman, Adrian Dunlop, Margaret Hellard, Julie Bruneau, Stefan Bourgeois, Maria C Thurnheer, Janaki Amin, Pip Marks, Sophie Quiene, Gregory J Dore, Olav Dalgard, and Jason Grebely

Theme: Clinical Research Year: 2016

Håvard Midgard1,2, Behzad Hajarizadeh2
, Evan Cunningham2
, Brian Conway3
, Markus
, Geert Robaeys5,6,7, Martin Weltman8
, Adrian Dunlop9
, Margaret Hellard10, Julie
Bruneau11, Stefan Bourgeois12, Maria C Thurnheer13, Janaki Amin2
, Pip Marks2
, Sophie Quiene2
Gregory J Dore2
, Olav Dalgard1*, and Jason Grebely2* on behalf of the ACTIVATE Study Group
*Contributed equally
1Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway, 2
The Kirby
Institute, UNSW Australia, Sydney, Australia, 3Vancouver Infectious Diseases Center, Vancouver,
Canada, 4
Ludwig Maximilians-University Munich, Munich, Germany, 5Department of
Gastroenterology and Hepatology, Ziekenhuis Oost Limburg, Genk, Belgium, 6Department of
Hepatology, UZ Leuven, Leuven, Belgium, 7
Faculty of Medicine and Life Sciences, Limburg
Clinical Research Program, Hasselt University, Hasselt, Belgium,
8Nepean Hospital, Sydney,
Australia, 9School of Medicine and Public Health, University of Newcastle, Newcastle, Australia,
10Burnet Institute, Melbourne, Australia, 11 CHUM Research Center, Université de Montréal,
Montreal, Canada, 12Stuivenberg ZNA, Antwerp, Belgium, 13Division of Infectious Diseases,
University Hospital and University of Bern, Bern, Switzerland.
Background: The potential risk of hepatitis C virus (HCV) reinfection due to continued injecting
risk behaviours might remain an important barrier to HCV treatment among people who inject
drugs (PWID). We aimed to evaluate changes in injecting risk behaviours during and following
HCV treatment among PWID enrolled in the ACTIVATE study.
Methods: The ACTIVATE study was an international, multicentre study of treatment for HCV
genotype 2 or 3 infection among people with ongoing (past 24 weeks) injecting drug use or on
opioid substitution treatment (OST). Between 2012 and 2014, participants were enrolled at 17
sites in Australia, Belgium, Canada, Germany, Norway, Switzerland and the United Kingdom
through a network of drug and alcohol clinics (n=3), office-based practices (n=2), hospital clinics
(n=9), and community clinics (n=3). Participants were treated with peg-interferon/ribavirin for 12 or
24 weeks and completed a self-administered behavioural questionnaire at each study visit.
Longitudinally measured behavioural outcomes were modelled as binary variables using
Generalized Estimating Equations.
Results: Among 93 enrolled participants (83% male, median age 41 years), 55 (59%) had injected
in the past month. Recent (past month) injecting drug use decreased during HCV treatment and
follow-up (aOR 0.88 per incremental study visit; 95% CI 0.83-0.95). No significant changes were
found in daily injecting (aOR 0.97; 95% CI 0.88-1.07), use of non-sterile needles (aOR 0.95; 95%
CI 0.79-1.13), sharing of injecting paraphernalia (aOR 0.87; 95% CI 0.70-1.07) or non-injecting
drug use (aOR 1.01; 95% CI 0.93-1.11). Hazardous alcohol use decreased during treatment and
follow-up (aOR 0.55; 95% CI 0.40-0.77) and OST increased between enrolment and end of
treatment (OR 1.48; 95% CI 1.07-2.04).
Conclusion: Recent injecting drug use and hazardous alcohol use decreased, while OST
increased during and following HCV treatment among participants with on-going injecting drug
use. These findings support further expansion of HCV care among PWID.
Disclosures: JG is a consultant/advisor and has received research grants from Abbvie, Bristol
Myers Squibb, Gilead Sciences and Merck. GD is a consultant/advisor and has received research
grants from Abbvie, Bristol Myers Squibb, Gilead Sciences, Merck, Janssen and Roche. SB is
consultant/advisor and has received grants from Abbvie, Bristol Myers Squibb, Gilead Sciences,
Janssen and Merck. OD is a consultant/advisor and has received research grants from Gilead
Sciences, Merck, Abbvie and Medivir. JB is a consultant/advisor and has received research grants
from Gilead Sciences and Merck. MW is a consultant/advisor and has received grants from
Abbvie, Gilead Sciences, MSD and Bristol Myers Squibb. MH has investigator initiated research
grants from Gilead Sciences, Abbvie and Bristol Myers Squibb.

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