Back HCV Treatment Active Injection Drug Users and Those on Opiate Substitution Treatment Can Have Good Hepatitis C Therapy Outcomes

Active Injection Drug Users and Those on Opiate Substitution Treatment Can Have Good Hepatitis C Therapy Outcomes

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.