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Treatment of intravenous drug users with chronic hepatitis C: treatment response, compliance and side effects

E Gigi1, E Sinakos, Th Lalla

  • 12nd Department of Medicine, Thessaloniki University Medical School, Hippokration Hospital, Thessaloniki, Greece. gileina@yahoo.gr

Hippokratia
|July 8, 2009
PubMed

Insights

Treatment for chronic hepatitis C in former intravenous drug users (IVDUs) showed effectiveness and safety. Achieving sustained virologic response (SVR) was higher with combination therapies, suggesting optimal pretreatment abstinence is key.

Area of Science:

  • Hepatology
  • Infectious Diseases
  • Addiction Medicine

Background:

  • Intravenous drug users (IVDUs) represent the majority of chronic hepatitis C (HCV) patients.
  • Many IVDUs are excluded from HCV treatment due to concerns regarding adherence and side effects.
  • This study focuses on non-methadone substituted former IVDUs with chronic HCV infection.

Purpose of the Study:

  • To retrospectively evaluate the safety, compliance, and efficacy of chronic hepatitis C treatment in former IVDUs.
  • To determine the impact of pretreatment drug abstinence duration on treatment outcomes.
  • To compare different treatment regimens including IFN-alpha monotherapy and combination therapies.

Main Methods:

  • Retrospective evaluation of 163 former IVDUs with chronic HCV infection treated between 1997-2004.
  • Subjects had HCV RNA positivity and elevated ALT levels, not on methadone substitution.
  • Treatment regimens included IFN-alpha monotherapy, IFN-alpha/ribavirin, and pegylated IFN-alpha/ribavirin.

Main Results:

  • 53.3% discontinued treatment early, primarily due to drug abuse relapse (62%) or side effects (32.1%).
  • Patients with pretreatment abstinence ≤9 months were more likely to discontinue treatment.
  • 71.05% achieved sustained virologic response (SVR), with significantly higher rates in combination therapy groups compared to monotherapy.

Conclusions:

  • HCV treatment is reasonably safe and effective in non-methadone substituted former IVDUs.
  • Early treatment discontinuation and drug abuse relapse are significant challenges.
  • A pretreatment abstinence period of at least 9 months is suggested for optimal outcomes.
Abstract

Keywords:
HCV infectionIFNα / IFNα ribavirin combination treatmentintravenous drug users

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