Active
Injection Drug Users and Those on Opiate Substitution Treatment Can Have Good
Hepatitis C Therapy Outcomes By
Liz Highleyman
 Active
injection drug users (IDUs) and those receiving opiate substitution can be successfully
treated for chronic hepatitis C virus (HCV) infection,
according to a French study presented at the 44th Annual
Meeting of the European Association for the Study of the Liver (EASL 2009)
last month in Copenhagen.
P.
Melin and colleagues described findings from CHEOBS, a multicenter, prospective,
observational study of factors associated with adherence to pegylated
interferon alfa-2b (PegIntron) plus ribavirin in chronic hepatitis C patients. The
present analysis focused on adherence to antiviral therapy, virological
response, and quality of life (QoL) according to whether participants were
active drug users or on substitution treatment, former drug users, or had not
used drugs (non-users). Between
2003 and 2006, 184 clinicians evaluated some 2000 chronic hepatitis C patients
every 3 months during antiviral therapy, and again at 6 months after the end of
therapy; 141 patients were excluded from the analysis for various reasons. The
study population included 244 active drug
users and patients on opiate substation, 578 former drug users, and 1038 non-users.
Good
adherence was defined as taking at least 80% of the prescribed doses of pegylated
interferon and ribavirin for at least 80% of the planned duration. Sustained
virological response (SVR) was defined as undetectable HCV RNA 12 weeks or
more after the end of antiviral therapy (Note: SVR is typically determined 24
weeks after completion of therapy). QoL was assessed using the SF-36 questionnaire. Results
The profile of the former drug user group fell between those of the active drug
user/substitution treatment group and the non-user group with regard to mean age,
body mass index (BMI), degree of liver fibrosis, level of education, level of
debt, consumption of alcohol, psychiatric disorders, and other chronic diseases.
Rates of good adherence to pegylated interferon/ribavirin were similar in all
3 groups: 48.6% for former drug users, 49.4% for non-users, and 52.2% for active
users and substitution treatment patients.
SVR rates were also similar, at 49.3% for non-users, 50.9% for former users, and
57.8% for active users and substitution patients.
QoL in the active user/substitution treatment group was less impaired on physical
and mental aspects compared with the other 2 groups.
"Excess
consumption of alcohol, a precarious socioeconomic situation, and the psychiatric
disorders observed in [active or substitution treatment] drug users in this study
had no negative impact on the treatment outcomes," the investigators concluded.
On
the contrary, they continued, young age, recent HCV infection, high prevalence
of easier-to-treat HCV genotype 3 infection, lower BMI, less severe liver fibrosis,
and good adherence to treatment "seem to have balanced the negative parameters." Hôpital
Général, Saint Dizier; Centre Hospitalier Erstein, Erstein; Institut
Arnaud Tzanck, Saint Laurent du Var; Hôpital de Créteil, Créteil;
ClinSearch, Bagneux; Centre de l'Appareil Digestif, Bourgoin Jallieu; Hôpital
Beaujon, Clichy; Hôpital Pitié-Salpêtrière AP HP, Paris,
France. 5/19/09 Reference
P
Melin, J-P Lang, D Ouzan, and others. Impact
of the Drug Use and Substitution Treatments on the Antiviral Treatment of Chronic
Hepatitis C: Analysis of Adherence, Virological Response and Quality of Life.
44th Annual Meeting of the European Association for the Study of the Liver (EASL
2009). Copenhagen, Denmark. April 22-26, 2009.
EASL
2009 MAIN PAGE
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