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Active Injection Drug Use Does Not Impair Sustained Response to Hepatitis C Treatment in Adherent Patients

In the July 10 advance online edition of the Journal of Viral Hepatitis, Philip Bruggmann from the Association for Risk Reduction in the Use of Drugs in Zurich, Switzerland and colleagues reported results from a study of hepatitis C treatment in active drug users. As background, the authors noted that the medical literature provides no evidence for an unequivocal treatment deferral of active IDUs.Chronic hepatitis C virus (HCV) infection is common among injection drug users (IDUs) since the virus is readily transmitted through shared needles and other drug use equipment.

Many clinicians, however, are reluctant to offer hepatitis C treatment to IDUs who continue active drug use, due to concerns such as poor adherence and increased risk of interferon-induced psychiatric side effects such as depression.

The investigators retrospectively analyzed the direct effect of injection drug use on treatment outcomes in 500 chronic hepatitis C patients enrolled in the Swiss Hepatitis C Cohort Study. Individuals were eligible for the study if they had at least 1 visit while receiving antiviral therapy documenting drug use status and an HCV RNA test 6 months after the end of treatment to assess sustained virological response (SVR). A total of 500 participants fulfilled the inclusion criteria: 199 IDUs and 301 non-drug-using control subjects.

Results

• 66.0% of IDUs and 60.5% of control subjects attained a minimum exposure to at least 80% of the scheduled cumulative dose of antiviral medications (a statistically non-significant difference).

• The overall SVR rate was 63.6%, and rates were not significantly different in the 2 groups:

• Active IDUs: 69.3%;
• Non-drug-using control subjects: 59.8%.

• A multivariate analysis for treatment success showed no significant negative influence of active injection drug use.

In conclusion, the authors wrote, "our study shows no relevant direct influence of IV drugs on the efficacy of anti-HCV therapy among adherent patients."

7/22/08

Reference

P Bruggmann, L Falcato, S Dober, and others. Active intravenous drug use during chronic hepatitis C therapy does not reduce sustained virological response rates in adherent patients. Journal of Viral Hepatitis. July 10, 2008 [Epub ahead of print].