TY - JOUR
KW - Adolescent
KW - Adult
KW - Buprenorphine/administration & dosage
KW - Cohort Studies
KW - Disease Transmission, Infectious/prevention & control
KW - Drug Users/statistics & numerical data
KW - Female
KW - Hepatitis C/epidemiology/prevention & control/transmission
KW - Humans
KW - Incidence
KW - Injections, Intravenous/adverse effects
KW - Male
KW - Methadone/administration & dosage
KW - Narcotics/administration & dosage
KW - Opiate Substitution Treatment/methods
KW - Opioid-Related Disorders/complications/drug therapy/epidemiology
KW - Poisson Distribution
KW - Proportional Hazards Models
KW - Substance Abuse, Intravenous/complications/drug therapy/epidemiology
KW - Young Adult
AU - J. I. Tsui
AU - J. L. Evans
AU - P. J. Lum
AU - J. A. Hahn
AU - K. Page
A1 - 
AB - IMPORTANCE: Injection drug use is the primary mode of transmission for hepatitis C virus (HCV) infection. Prior studies suggest opioid agonist therapy may reduce the incidence of HCV infection among injection drug users; however, little is known about the effects of this therapy in younger users. OBJECTIVE: To evaluate whether opioid agonist therapy was associated with a lower incidence of HCV infection in a cohort of young adult injection drug users. DESIGN, SETTING, AND PARTICIPANTS: Observational cohort study conducted from January 3, 2000, through August 21, 2013, with quarterly interviews and blood sampling. We recruited young adult (younger than 30 years) injection drug users who were negative for anti-HCV antibody and/or HCV RNA. EXPOSURES: Substance use treatment within the past 3 months, including non-opioid agonist forms of treatment, opioid agonist (methadone hydrochloride or buprenorphine hydrochloride) detoxification or maintenance therapy, or no treatment. MAIN OUTCOMES AND MEASURES: Incident HCV infection documented with a new positive result for HCV RNA and/or HCV antibodies. Cumulative incidence rates (95% CI) of HCV infection were calculated assuming a Poisson distribution. Cox proportional hazards regression models were fit adjusting for age, sex, race, years of injection drug use, homelessness, and incarceration. RESULTS: Baseline characteristics of the sample (n = 552) included median age of 23 (interquartile range, 20-26) years; 31.9% female; 73.1% white; 39.7% who did not graduate from high school; and 69.2% who were homeless. During the observation period of 680 person-years, 171 incident cases of HCV infection occurred (incidence rate, 25.1 [95% CI, 21.6-29.2] per 100 person-years). The rate ratio was significantly lower for participants who reported recent maintenance opioid agonist therapy (0.31 [95% CI, 0.14-0.65]; P = .001) but not for those who reported recent non-opioid agonist forms of treatment (0.63 [95% CI, 0.37-1.08]; P = .09) or opioid agonist detoxification (1.45 [95% CI, 0.80-2.69]; P = .23). After adjustment for other covariates, maintenance opioid agonist therapy was associated with lower relative hazards for acquiring HCV infection over time (adjusted hazard ratio, 0.39 [95% CI, 0.18-0.87]; P = .02). CONCLUSIONS AND RELEVANCE: In this cohort of young adult injection drug users, recent maintenance opioid agonist therapy was associated with a lower incidence of HCV infection. Maintenance treatment with methadone or buprenorphine for opioid use disorders may be an important strategy to prevent the spread of HCV infection among young injection drug users.
BT - JAMA internal medicine
C5 - Opioids & Substance Use
CP - 12
CY - United States
DO - 10.1001/jamainternmed.2014.5416
IS - 12
JF - JAMA internal medicine
N2 - IMPORTANCE: Injection drug use is the primary mode of transmission for hepatitis C virus (HCV) infection. Prior studies suggest opioid agonist therapy may reduce the incidence of HCV infection among injection drug users; however, little is known about the effects of this therapy in younger users. OBJECTIVE: To evaluate whether opioid agonist therapy was associated with a lower incidence of HCV infection in a cohort of young adult injection drug users. DESIGN, SETTING, AND PARTICIPANTS: Observational cohort study conducted from January 3, 2000, through August 21, 2013, with quarterly interviews and blood sampling. We recruited young adult (younger than 30 years) injection drug users who were negative for anti-HCV antibody and/or HCV RNA. EXPOSURES: Substance use treatment within the past 3 months, including non-opioid agonist forms of treatment, opioid agonist (methadone hydrochloride or buprenorphine hydrochloride) detoxification or maintenance therapy, or no treatment. MAIN OUTCOMES AND MEASURES: Incident HCV infection documented with a new positive result for HCV RNA and/or HCV antibodies. Cumulative incidence rates (95% CI) of HCV infection were calculated assuming a Poisson distribution. Cox proportional hazards regression models were fit adjusting for age, sex, race, years of injection drug use, homelessness, and incarceration. RESULTS: Baseline characteristics of the sample (n = 552) included median age of 23 (interquartile range, 20-26) years; 31.9% female; 73.1% white; 39.7% who did not graduate from high school; and 69.2% who were homeless. During the observation period of 680 person-years, 171 incident cases of HCV infection occurred (incidence rate, 25.1 [95% CI, 21.6-29.2] per 100 person-years). The rate ratio was significantly lower for participants who reported recent maintenance opioid agonist therapy (0.31 [95% CI, 0.14-0.65]; P = .001) but not for those who reported recent non-opioid agonist forms of treatment (0.63 [95% CI, 0.37-1.08]; P = .09) or opioid agonist detoxification (1.45 [95% CI, 0.80-2.69]; P = .23). After adjustment for other covariates, maintenance opioid agonist therapy was associated with lower relative hazards for acquiring HCV infection over time (adjusted hazard ratio, 0.39 [95% CI, 0.18-0.87]; P = .02). CONCLUSIONS AND RELEVANCE: In this cohort of young adult injection drug users, recent maintenance opioid agonist therapy was associated with a lower incidence of HCV infection. Maintenance treatment with methadone or buprenorphine for opioid use disorders may be an important strategy to prevent the spread of HCV infection among young injection drug users.
PP - United States
PY - 2014
SN - 2168-6114; 2168-6106
SP - 1974
EP - 1981
EP - 
T1 - Association of opioid agonist therapy with lower incidence of hepatitis C virus infection in young adult injection drug users
T2 - JAMA internal medicine
TI - Association of opioid agonist therapy with lower incidence of hepatitis C virus infection in young adult injection drug users
U1 - Opioids & Substance Use
U2 - 25347412
U3 - 10.1001/jamainternmed.2014.5416
VL - 174
VO - 2168-6114; 2168-6106
Y1 - 2014
ER -