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Critical issues in the treatment of hepatitis C virus infection in methadone maintenance patients

David M Novick1, Mary Jeanne Kreek

  • 1Rockefeller University, New York, NY, USA. dnovick@digestivespecialists.com

Addiction (Abingdon, England)
|April 22, 2008
PubMed

Insights

Hepatitis C virus (HCV) infection is prevalent in patients undergoing methadone maintenance. Antiviral therapies show high sustained virological response (SVR) rates and excellent completion in these individuals.

Area of Science:

  • Hepatology
  • Infectious Diseases
  • Addiction Medicine

Background:

  • Hepatitis C virus (HCV) infection is a frequent complication of injection drug use.
  • Methadone maintenance programs serve a significant population of HCV-infected individuals.
  • Co-infection with human immunodeficiency virus (HIV) is common in this patient group.

Purpose of the Study:

  • To review HCV infection in patients undergoing opioid maintenance therapy.
  • To emphasize the medical care of HCV-monoinfected and HCV/HIV-coinfected patients on methadone or buprenorphine.
  • To explore antiviral therapy and liver transplantation options for this population.

Main Methods:

  • Literature searches were conducted using PubMed, PsycINFO, and SocINDEX.
  • The search focused on papers from 1990 to the present.
  • Key topics included antiviral therapy and liver transplantation in methadone maintenance patients.

Main Results:

  • HCV antibody prevalence is high in injection drug users (53-96%) and methadone patients (67-96%).
  • Antiviral therapy for HCV in methadone patients yields sustained virological response (SVR) rates of 28-94% with excellent completion rates (72-100%).
  • Liver transplantation has shown success in methadone patients but is underutilized.

Conclusions:

  • High-quality medical care for HCV is feasible for methadone maintenance patients.
  • Evidence supports the effectiveness of comprehensive HCV services for this population.
  • Despite evidence, most patients currently do not receive adequate HCV care.
Abstract

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