Active and Recovering Injection Drug Users Can Benefit from Hepatitis C Treatment if They Maintain Good Adherence
Active and Recovering Injection Drug Users Can Benefit from Hepatitis C
Treatment if They Maintain Good Adherence
By Liz Highleyman
Because hepatitis C virus (HCV) can be transmitted via shared needles and other
drug-injection equipment, a high proportion of active and former injection drug
users (IDUs) have chronic hepatitis C.
Traditionally, some experts have felt that IDUs - particularly those who
continue active drug use - are unsuitable for interferon-based therapy because
they tend to be difficult to treat and have poor outcomes. Recent research,
however, contradicts this belief, and National Institutes of Health (NIH)
consensus guidelines state that IDUs, especially those on methadone maintenance
or similar opiate substitution therapy, should not be routinely denied
treatment.
As reported at the Digestive Disease Week 2008 conference last month in San
Diego, Olga Anagnostou and colleagues evaluated hepatitis C treatment adherence
and response rates among IDUs and investigated factors influencing outcomes.
The study included 104 IDUs with chronic hepatitis C who received combination
therapy with conventional or pegylated interferon plus ribavirin between 2000
and 2007. Most (77) were men and the mean age was 37 years (range 19-58 years);
34 had HCV genotypes 1 or 4, while 57 had genotype 3. Seven had histological
evidence of cirrhosis, but none had decompensated liver disease.
Among the participants, 45 (43.3%) were receiving maintenance opiate
substitution treatment, 39 (37.5%) injected drugs in the past, and 20 (13%)
continued active injection drug use.
Treatment adherence, end-of-treatment response (ETR), and sustained virological
response (SVR) 24 weeks after completion of therapy were assessed and correlated
with patient characteristics.
Results
. 30 of the 104 participants (28.8%) discontinued anti-HCV treatment
prematurely, after a mean of 3 months.
. 13 participants (12.5%) discontinued therapy due to major side effects
and 17 (16.3%) did so due to personal decision.
. By subgroup, 76% of past users, 65% of active users, and 60% of those
on methadone maintenance completed anti-HCV therapy (a non-significant
difference).
. Multivariate analysis including age, sex, active or past drug use,
substitution treatment, HCV genotype, duration of therapy, and current alcohol
consumption did not reveal any significant association with adherence.
. Among the 74 patients who completed interferon-based therapy, 47
(64.4%) achieved SVR, while another 13 (17.6%) experienced ETR with subsequent
viral relapse.
. There was no significant difference in SVR rates between past users
(57.9%), active users (71.4%), and individuals on methadone maintenance (71.4%).
. In a multivariate analysis, younger age and male sex were associated
with SVR.
"Our data clearly suggest that, as long as [IDU] patients with chronic hepatitis
C keep adherent, chronic hepatitis C therapy is effective," the investigators
concluded.
"Active drug users and patients on substitution maintenance treatment do not
differ from past users in terms of SVR and compliance to hepatitis C treatment,"
they continued. "SVR in those patients is similar [to] that expected in the
general chronic hepatitis C population."
Therefore, the researchers recommended, "[IDUs] with chronic hepatitis C
infection -- especially when they are on substitution treatment -- should not be
excluded from treatment."
6/10/08
Reference
O Anagnostou, S Manolakopoulos, M Deutsch, and others. Drug Users with chronic
hepatitis C who are adherent to antiviral treatment will finally benefit from
therapy. Digestive Disease Week (DDW) 2008. San Diego, CA. May 17-22, 2008.
Abstract S1013.
http://www.hivandhepatitis.com/2008icr/ddw/docs/061008_c.html