• Andreea A Artenie, Nanor Minoyan, Brendan Jacka, Stine Høj, Didier Jutras-Aswad, Élise Roy, Lise Gauvin, Geng Zang, and Julie Bruneau.
• Department of Social and Preventive Medicine (Artenie, Minoyan, Gauvin), School of Public Health, Université de Montréal; Research Centre (Artenie, Minoyan, Jacka, Høj, Jutras-Aswad, Gauvin, Zang, Bruneau), Centre Hospitalier de l'Université de Montréal; Department of Psychiatry (Jutras-Aswad), Université de Montréal, Montréal, Que.; Addiction Studies and Research Program (Roy), Université de Sherbrooke, Longueuil, Que.; Institut national de santé publique du Québec (Roy); Department of Family and Emergency Medicine (Bruneau), Université de Montréal, Montréal, Que.
• CMAJ. 2019 Apr 29; 191 (17): E462-E468.

BackgroundOpioid agonist treatment is considered important in preventing acquisition of hepatitis C virus (HCV) among people who inject drugs; however, the role of dosage in opioid agonist treatment is unclear. We investigated the joint association of prescribed dosage of opioid agonist treatment and patient-perceived dosage adequacy with risk of HCV infection among people who inject drugs.MethodsWe followed prospectively people who inject drugs at risk of acquiring HCV infection (who were RNA negative and HCV-antibody negative or positive) in Montréal, Canada (2004-2017). At 6-month, then 3-month intervals, participants were tested for HCV antibodies or RNA, and completed an interviewer-administered behavioural questionnaire, reporting the following: current exposure to opioid agonist treatment (yes/no), prescribed dosage either high (methadone ≥ 60 mg/d or buprenorphine ≥ 16 mg/d) or low, and perceived dosage adequacy (adequate/inadequate). We then assigned participants to 1 of 5 exposure categories: no opioid agonist treatment, high dosage of opioid agonist treatment perceived to be adequate, high dosage perceived to be inadequate, low dosage perceived to be adequate or low dosage perceived to be inadequate. To estimate associations between categories of opioid agonist treatment dosage and incident HCV infection, we conducted Cox regression analyses, adjusting for multiple confounding factors.ResultsOf 513 participants (median age 35.0 yr, 77.6% male), 168 acquired HCV over 1422.6 person-years of follow-up (incidence 11.8/100 person-years, 95% confidence interval [CI] 10.1-13.7). We observed a gradient in the relative risks of HCV infection across categories of opioid agonist treatment dosage. Compared with people who inject drugs not receiving opioid agonist treatment, adjusted hazard ratios were 0.43 (95% CI 0.23-0.84) for those receiving high dosages perceived to be adequate, 0.61 (95% CI 0.25-1.50) for those receiving high dosages perceived to be inadequate, 1.22 (95% CI 0.74-2.00) for those receiving low dosages perceived to be adequate and 1.94 (95% CI 1.11-3.39) for those receiving low dosages perceived to be inadequate.InterpretationRisk of HCV infection varies considerably according to dosage of opioid agonist treatment and patient-perceived adequacy, with associations indicating both protective and harmful effects relative to no exposure to opioid agonist treatment.© 2019 Joule Inc. or its licensors.

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