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Sex-Specific Risk Factors and Health Disparity Among Hepatitis C Positive Patients Receiving Pharmacotherapy for
Brittany B Dennis1, Leslie J Martin, Leen Naji
1From the Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada (BBD, LJM, AW, TO); Department of Family Medicine, Michael DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada (LN); Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford University, CA (BBD, GC, DK, AA); Department of Medicine, University of British Columbia, Vancouver Costal Health, Vancouver, Canada (DA); Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada (NS, AH, CC, AD, BP, ZS); Department of Health Research Evaluation and Impact (Formerly Department of Clinical Epidemiology and Biostatistics), McMaster University, Hamilton, ON, Canada (LN, AW, LT, ZS); Northern Ontario School of Medicine, Sudbury ON, Canada (DCM); Canadian Addiction Treatment Centres, Markham ON, Canada (DCM); Guys and St. Thomas Hospital NHS Trust, London, United Kingdom (MB); Centre for Evaluation of Medicine, Hamilton, ON, Canada (LT); System Linked Research Unit, Hamilton, ON, Canada (LT); Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, ON, Canada (ZS).
Insights
Hepatitis C virus (HCV) infection is linked to poorer outcomes in medication for opioid use disorder (MOUD) treatment, especially for women. Further research is needed to address sex-based disparities in care.
Area of Science:
- Addiction Medicine
- Hepatology
- Public Health
Background:
- Opioid-related fatalities are a major public health crisis.
- Patients with comorbid Hepatitis C Virus (HCV) present unique treatment challenges.
- Understanding HCV's impact on opioid use disorder (OUD) treatment is critical.
Purpose of the Study:
- To re-examine the impact of HCV on response to medication for opioid use disorder (MOUD).
- To identify sex-specific risk factors influencing MOUD treatment outcomes in HCV-positive patients.
Main Methods:
- Multi-center prospective cohort study with 1-year follow-up.
- Inclusion of patients (≥18 years) receiving methadone for OUD.
- Propensity score matching and sex-specific regression models to analyze HCV impact and risk factors.
Main Results:
- HCV was prevalent in 25% of participants (n=307).
- HCV patients showed significantly higher rates of high-risk opioid consumption.
- Female patients with HCV had a 2-fold increased risk for high-risk opioid consumption behaviors.
Conclusions:
- HCV is associated with poorer MOUD treatment response, with higher risks observed in female patients.
- Addressing sex-based disparities and implementing trauma-informed care are crucial.
- Further research is needed to understand and mitigate these disparities.
Background:
The incidence of opioid-related fatality has reached unparalleled levels across North America. Patients with comorbid hepatitis C virus (HCV) remain the most vulnerable and difficult to treat. Considering the unique challenges associated with this population, we aimed to re-examine the impact of HCV on response to medication assistant treatment for opioid use disorder and establish sex-specific risk factors affecting care.
Methods:
This study employs a multi-center prospective cohort design, with 1-year follow-up. Patients aged ≥18, receiving methadone for opioid use disorder were recruited from a network of outpatient opioid addiction treatment centers across Southern Ontario, Canada. Patients with ≥50% positive opioid urine screens over 1 year of follow-up were classified as poor responders. The prognostic impact of HCV on response was established using a propensity score matched analysis. Sex-specific regression models were constructed to evaluate risk factors for treatment response.
Results:
Among participants eligible for inclusion (n = 1234), HCV was prevalent in 25% (n = 307). HCV patients exhibited significantly higher rates of high-risk opioid consumption patterns 35.29% (standard deviation 0.478). Sex-specific examination revealed females with HCV incur a 2 times increased risk for high-risk opioid consumption behaviors (female odds ratio: 1.95, 95% confidence interval 1.23, 3.10; P = 0.01).
Conclusions:
Findings from this study establish the link between HCV and poor treatment response, with differentially higher risk among female patients. In light of the high potential for overdose among this population, concerted efforts are required for distinguishing the source for sex-based disparities, in addition to establishing trauma and gender informed treatment protocols.
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