Factors and HCV treatment outcomes associated with smoking among people who inject drugs on opioid agonist treatment: secondary analysis of the PREVAIL randomized clinical trial

Irene Pericot-Valverde,Jiajing Niu,Moonseong Heo,Matthew J Akiyama,Brianna L Norton,Linda Agyemang,Alain H Litwin

doi:10.1186/s12879-020-05667-3

Abstract

BackgroundCigarette smoking has emerged as a leading cause of mortality among people with hepatitis C virus (HCV). People who inject drugs (PWID) represent the largest group of adults infected with HCV in the US. However, cigarette smoking remains virtually unexplored among this population. This study aimed at (1) determining prevalence and correlates of cigarette smoking among HCV-infected PWID enrolled in opiate agonist treatment programs; (2) exploring the association of smoking with HCV treatment outcomes including adherence, treatment completion and sustained virologic response (SVR); and 3) exploring whether cigarette smoking decreased after HCV treatment.MethodsParticipants were 150 HCV-infected PWID enrolled in a randomized clinical trial primarily designed to test three intensive models of HCV care. Assessments included sociodemographics, presence of chronic health and psychiatric comorbidities, prior and current drug use, quality of life, and HCV treatment outcomes.ResultsThe majority of the patients (84%) were current cigarette smokers at baseline. There was a high prevalence of psychiatric and medical comorbidities in the overall sample of PWID. Alcohol and cocaine use were identified as correlates of cigarette smoking. Smoking status did not influence HCV treatment outcomes including adherence, treatment completion and SVR. HCV treatment was not associated with decreased cigarette smoking.ConclusionsThe present study showed high prevalence of cigarette smoking among this population as well as identified correlates of smoking, namely alcohol and cocaine use. Cigarette smoking was not associated with HCV treatment outcomes. Given the detrimental effects that cigarette smoking and other co-occurring, substance use behaviors have on HCV-infected individuals’ health, it is imperative that clinicians treating HCV also target smoking, especially among PWID. The high prevalence of cigarette smoking among PWID will contribute to growing morbidity and mortality among this population even if cured of HCV. Tailored smoking cessation interventions for PWID along with HCV treatment may need to be put into clinical practice.Trial registrationNCT01857245. Registered May 20, 2013.

Highlights

Cigarette smoking has emerged as a leading cause of mortality among people with hepatitis C virus (HCV)
Cigarette smoking was not associated with Hepatitis C virus (HCV) treatment outcomes
Given the detrimental effects that cigarette smoking and other co-occurring, substance use behaviors have on HCV-infected individuals’ health, it is imperative that clinicians treating HCV target smoking, especially among People Who Inject Drugs (PWID)

Summary

Introduction

Cigarette smoking has emerged as a leading cause of mortality among people with hepatitis C virus (HCV). Despite the availability of highly effective oral direct-acting antiviral (DAA) medications with cure rates >95% [2], mortality rates in patients with HCV remain very high and surpasses any other chronic infectious diseases, including human immunodeficiency virus (HIV) [3]. Cigarette smoking has emerged as a leading cause of mortality among people with HCV [4]. Epidemiological data suggests that many chronic health conditions associated with cigarette smoking, such as non-hepatic cancers, cardiovascular disease, and respiratory conditions, have become a major cause of mortality among the HCV-infected population [5, 6].

Objectives

Methods

Results

Conclusion