Intravenous Drug Use

Not a Barrier to Achieving a Sustained Virological Response in HCV Infection

H. Jafferbhoy; M.H. Miller; J.K. Dunbar; J. Tait; S. Mcleod; J.F. Dillon

Disclosures

J Viral Hepat. 2012;19(2):112-119. 

In This Article

Abstract and Introduction

Abstract

Hepatitis C virus (HCV) is commonly transmitted by intravenous drug use (IDU) but drug users are under represented in many treatment cohorts, this is because of the assumption of lowered treatment success. We assessed HCV treatment outcomes in active intravenous drug users and patients on opiate substitution therapy. The Tayside HCV treatment database was retrospectively analysed for consecutively treated patients based on risk factor for acquisition of HCV. Primary end point was sustained virological response (SVR). Two hundred and ninety-one consecutively treated patients were assessed. The overall SVR rate was 55.3%. The SVR rates by risk factor were; Non-IDU 61.4%, Ex-IDU 54.8% and Active IDU 47.1% (P = n/s). In the groups G1 patients SVR was; Non-IDU 52.7%, Ex–IDU 30.7% and active IDU 35.4% (P = n/s). In the non-G1 patients: non-IDU 65.1%, Ex-IDU 76.7% and active IDU 53.5%. Ex-IDU had a significantly better SVR than active IDU, other differences were not significant. Our results demonstrate that SVR rates in the active drug users and those on opiate substitution therapy can be achieved which are comparable with non-IDU infected individuals. Intravenous drug use in those engaged with treatment services should not be seen as a barrier to treatment of HCV.

Introduction

Hepatitis C (hepatitis C virus, HCV) is a chronic blood borne viral infection. According to the World Health Organization, 2.2% or 170 million people in the world are infected and there is wide geographical variations.[1,2] Today, the cardinal risk factor in the Western World is intravenous drug use (IDU).[3] Despite various prevention strategies, the incidence of HCV in the IDU population has remained high ranging between 30% and 90%. Currently the standard treatment is a combination of pegylated interferon and ribavarin which, depending on the HCV genotype and disease stage, can lead to cure rates ranging between 30% and 80%.[4–6] The key variable in treatment success is adherence to the arduous regime, often up to 48 weeks duration.[5]

The need for adherence to therapy and monitoring, both to ensure patient safety and successful treatment, was often used to regard IDU as a relative contraindication to therapy.[7,8] This was both on grounds of safety and the fear that lowered treatment success would reduce the cost effectiveness of therapy. However the barriers to treatment in the HCV population with coexisting drug misuse are multifactorial.[9] The patient, care provider and the system all need to be streamlined in a fashion to provide equal treatment opportunity to this vulnerable group. Key to this is collaboration between HCV specialist services and drug staff to avoid fragmentation of services, a greater awareness of the risks posed by HCV to these individuals in the long term and the benefits of therapy, with such care pathways in place it may increase adherence with therapy in this group.

Aim

To ascertain, in routine clinical practice, the outcomes of treating individuals with HCV who are active intravenous drug users or are on opiate substitution therapy such as methadone. The primary outcome measure was the rate of sustained virological response (SVR) in those from an IDU background compared with those infected by other aetiologies. We hypothesize that a patient focussed treatment pathway negates other influences on achieving a SVR in this group of patients.

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