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Abstract Details
Non-adherence to LDV/SOF did not predict SVR in a randomized controlled trial of HIV/HCV coinfected persons who use drugs
Kathleen M Ward1, Oluwaseun Falade-Nwulia1, Juhi Moon1, Catherine G Sutcliffe2, Sherilyn Brinkley1, Taryn Haselhuhn1, Stephanie Katz1, Kayla Herne1, Lilian Arteaga1, Shruti H Mehta2, Carl Latkin3, Robert K Brooner4, Mark S Sulkowski1
Author information
1Department of Medicine, Johns Hopkins School of Medicine, Baltimore MD, USA.
2Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA.
3Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA.
4Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore MD, USA.
Abstract
Background: 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 HIV/HCV coinfection.
Methods: Of the 144 participants with HIV/HCV and SUDs, 110 initiated a 12-week treatment course under one of three 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).
Results: 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 low adherence, 28%. Although low adherence was associated with moderate/heavy alcohol use by PEth (RR 2.77, 95% CI 1.50-5.12), SVR did not vary according to adherence (p=0.702), and most participants (97%) with low adherence achieved SVR.
Conclusion: Treatment persistence led to high SVR rates among persons with HIV/HCV, despite imperfect adherence and SUDs.