Difficulties with interferon treatment in former intravenous drug users

Gazdag, Gábor; Horváth, Gergely; Szabó, Olga; Ungvari, Gabor S.

doi:10.1016/S1413-8670(11)70164-7

Article information

Abstract

Objectives

Intravenous drug use accounts for most of the new hepatitis C infections worldwide. Although there is an urgent need for antiviral treatment of infected intravenous drug users (IDUs), several factors compromise their treatment including lack of treatment adherence and high dropout rate. The aim of this study was to compare antiviral treatment-related problems among former IDUs to HCV-infected patients without a history of IDU.

Methods

This was a retrospective chart review of HCV-infected IDUs who received combined antiviral therapy at the Hepatology Outpatient Clinic of Szent László Hospital between 1 January 2006 and 31 December 2008. A control group of interferon treated patients with no history of IDU matched for age and sex was selected.

Results

Dropout rate was significantly higher in the IDU group (p=0.016). Treatment response at the 12th week of treatment was significantly better in the IDU group (p=0.004). Significantly more IDUs underwent antiviral treatment while in prison (p=0.008).

Conclusions

In this study higher dropout rate was found among IDUs. IDUs had a better response rate to antiviral therapy compared to controls. More attention should be paid to factors that worsen treatment adherence of IDUs - particularly lack of abstinence - in order to increase the effectiveness of antiviral therapy.

Keywords:

psychiatry

hepatitis C

substance-related disorders

Full text is only aviable in PDF

References

[1.]

G.L. Quaglio, F. Lugoboni, B. Pajusco, et al.

Hepatitis C virus infection: prevalence, predictor variables and prevention opportunities among drug users in Italy.

J Viral Hepat, 10 (2003), pp. 394-400

Medline

[2.]

M. Gerlich, P. Gschwend, A. Uchtenhagen, A. Krämer, J. Rehm.

Prevalence of hepatitis and HIV infections and vaccination rates in patients entering the heroin-assisted treatment in Switzerland between 1994 and 2002.

Eur J Epidemiol, 21 (2006), pp. 545-549

http://dx.doi.org/10.1007/s10654-006-9023-z | Medline

[3.]

C. Lidman, L. Norden, M. Kabera, et al.

Hepatitis C infection among injection drug users in Stockholm Sweden: Prevalence and gender.

Scand J Infect Dis Jun, 11 (2009), pp. 1-6

[4.]

J. Gerevich.

A drogfogyasztók ambuláns kezelésének szempontjai. (Issues in the outpatient treatment of drug addict patients.).

Addikciók (Addictions), pp. 52-72

[5.]

H. Osztrogonácz, J. Gerevich, G. Horváth, G. Tolvaj, K. Dávid.

Prevalence of chronic viral hepatitis in drug abusers.

Orv Hetil, 141 (2000), pp. 715-718

Medline

[6.]

Á. Csohán, J. Csorba, É. Keller, G. Zacher.

A drogfogyasztás egészségügyi vonatkozásai és következményei. (Health aspects and consequences of drug abuse.).

Jelentés a magyarországi kábítószerhelyzetről (Report about the Hungarian drug situation), pp. 81-89

[7.]

I.G. Takács.

HIV- és hepatitiszprevalenciák alakulása az intravénás használók között. (Tendencies of HIV and hepatitis prevalence in intravenous drug users.).

Drogpolitika számokban. (Drug policy in numbers.), pp. 265-268

[8.]

O. Reichard, G. Norkgrans, A. Frydén, J.H. Braconier, A. Sönnerborg, O. Weiland.

Comparison of 3 quantitative HCV RNA assays-accuracy of baseline viral load to predict treatment outcome in chronic hepatitis C.

Scand J Infect Dis, 30 (1998), pp. 441-446

Medline

[9.]

T. Poynard, P. Marcellin, S.S. Lee, et al.

Randomised trial of interferon alpha2b plus ribavirin for 48 weeks or for 24 weeks versus interferon alpha2b plus placebo for 48 weeks for treatment of chronic infection with hepatitis C virus. International Hepatitis Interventional Therapy Group (IHIT).

Lancet, 352 (1998), pp. 1426-1432

Medline

[10.]

S.L. Jowett, K. Agarwal, B.C. Smith, et al.

Managing chronic hepatitis C acquired through intravenous drug use.

Q J Med, 94 (2001), pp. 153-158

[11.]

M.A. Serfaty, A. Lawrine, B. Smith, et al.

Risk factors and medical follow up of drug users tested for hepatitis C – can the risk of transmission be reduced?.

Drug Alcohol Rev, 16 (1997), pp. 339-347

http://dx.doi.org/10.1080/09595239700186721 | Medline

[12.]

M. Hellard, R. Sacks-Davis, J. Gold.

Hepatitis C treatment for injecting drug users: a review of the available evidence.

Clin Inf Dis, 49 (2009), pp. 561-573

[13.]

M. Schaefer, F. Schmidt, C. Folwaczny, et al.

Adherence and mental side effects during hepatitis C treatment with interferon alfa and ribavirin in psychiatric risk groups.

Hepatology, 37 (2003), pp. 443-451

http://dx.doi.org/10.1053/jhep.2003.50031 | Medline

[14.]

M. Cournot, A. Glibert, F. Castel, et al.

Management of hepatitis C in active drug users: experience of an addiction care hepatology unit.

Gastroenterol Clin Biol, 28 (2004), pp. 533-539

Medline

[15.]

Nemzeti Drog Fókuszpont: 2009-es éves jelentés a magyarországi kábítószer helyzetről az EMCDDA számára. 6.2 fejezet. (Hungarian Drug Focal Point: 2009 report on the drug use in Hungary for EMCDDA. Chapter 6.2) NFP, Budapest, 2009.

[16.]

J. Shad, J. Person, O. Brann, et al.

How often are referred chronic hepatitis C patients candidates for antiviral therapy (Abstract).

Hepatology, 32 (2000), pp. 283A

[17.]

K.H. Seal, S.L. Currie, H. Shen, et al.

Hepatitis C treatment candidacy and outcomes among 4318 US veterans with chronic hepatitis C virus infection: does a history of injection drog use matter?.

J Clin Gastroenterol, 41 (2007), pp. 199-205

http://dx.doi.org/10.1097/01.mcg.0000212644.82853.51 | Medline

[18.]

G. Robaeys, H. Van Vlierberghe, C. Mathei, et al.

Similar compliance and effect of treatment in chronic hepatitis C resulting from intravenous drug use in comparison with other infection causes.

Eur J Gastroenterol Hepatol, 18 (2006), pp. 159-166

Medline

[19.]

B. Galeazzi, A. Tufano, E. Barbierato, F. Bortolotti.

Hepatitis C virus infection in Italian intravenous drug users: epidemiological and clinical aspects.

Liver, 15 (1995), pp. 209-212

Medline