Should active injecting drug users receive treatment for chronic hepatitis C?

Abstract

-Context -Accumulating data propose that active injecting drug users might not differ from the general population in terms of sustained virological response when adherent to therapy for chronic hepatitis C. However, current guidelines contain restrictive recommendations for therapy in this group of patients. Objective -Therefore, we evaluated a cohort of chronic hepatitis C patients regarding the potent influence of active drug using on initial informed consent, compliance and sustained virological response to treatment. Method -For that purpose, 162 consecutive patients (of which 62 active injecting drug users), who had been evaluated during the last 6 years in our center for chronic hepatitis C and proposed to receive treatment with pegylated interferon alpha and ribavirin, were enrolled. Initial informed consent, compliance, and sustained virological response as well as data regarding age, gender, body mass index, genotype, viral load, coinfection with HBV/HDV/HIV, administered interferon alpha (2a or 2b), liver function tests, liver histology, urban residence, ethnicity, and concomitant use of alcohol were collected and analyzed in respect with injecting drug using. Results -Injecting drug using was positively correlated with male gender (P<0.001), young age (P<0.001), native origin (P = 0.043), and concomitant use of alcohol (P<0.001). Comparable initial informed consent (P = 0.836), compliance (P = 0.879), and sustained virological response (P = 0.132) were observed between injecting drug users and non-injecting drug users. The results were confirmed using a multiple regression model. Conclusion -Our data further support that active injecting drug users do not constitute a distinct chronic hepatitis C patient group in terms of initial informed consent, compliance, or sustained virological response. Therefore, injecting drug using should not be a major determinant influencing the decision for treatment of chronic hepatitis C in eligible patients.

Hepatitis C Virus Infection Epidemiology among People Who Inject Drugs in Europe: A Systematic Review of Data for Scaling Up Treatment and Prevention

“…HCV genotype 2 is relatively uncommon with the exception of Greece [106], [132], Lithuania [138], Sweden [112] and the UK [82], [145], [147]. Genotype 3 predominates in Greece [106], [129], [130], [133], [134], Poland [139] and Slovenia [141] and is common in Austria [120], Belgium [91], France [103], [125] and Italy [136], [137].…”

“…Sixty-two studies [22], [61], [71], [82], [86], [92], [96], [98], [99], [103], [106], [109], [111], [116], [118], [122], [129], [132], [134], [146], [148]–[189] met the inclusion criteria giving 80 HIV-HCV co-infection estimates. (Table S6 in Web-appendix S2).…”

Recommendations for the management of hepatitis C virus infection among people who inject drugs

“…Recent drug use at treatment initiation has limited impact on adherence (Grebely, Matthews, Hellard, et al, 2011; Manolakopoulos et al, 2010; Marcellin et al, 2011; Sola et al, 2006; Sylvestre & Clements, 2007; Wilkinson et al, 2009), treatment completion (Grebely, Matthews, Hellard, et al, 2011; Hellard et al, 2009;Manolakopoulos et al, 2010; Papadopoulos et al, 2010), or SVR (Aspinall et al, 2013; Bruggmann et al, 2008; Dore et al, 2010; Grebely, Raffa, et al, 2007; Lindenburg et al, 2011; Manolakopoulos et al, 2010; Papadopoulos et al, 2010; Sasadeusz et al, 2011; Sylvestre et al, 2005). Some studies have reported lower treatment completion in those with recent drug use at treatment initiation (Hellard et al, 2009; Jafferbhoy et al, 2012).…”

“…Successful HCV treatment studies among PWID challenged this paradigm (Alvarez-Uria, Day, Nasir, Russell, & Vilar, 2009; Aspinall et al, 2013; Backmund, Meyer, Von Zielonka, & Eichenlaub, 2001; Bruggmann et al, 2008; Dalgard, 2005; Dimova et al, 2013; Dore et al, 2010; Grebely, Genoway, et al, 2007; Grebely et al, 2010; Grebely, Raffa, et al, 2007; Guadagnino et al, 2007; Hellard, Sacks-Davis, & Gold, 2009; Jack, Willott, Manners, Varnam, & Thomson, 2009; Jafferbhoy et al, 2012; Jeffrey et al, 2007; Lindenburg et al, 2011; Manolakopoulos et al, 2010; Martinez et al, 2010; Matthews, Kronborg, & Dore, 2005; Mauss, Berger, Goelz, Jacob, & Schmutz, 2004; Melin et al, 2010; Neri et al, 2002; Papadopoulos, Gogou, Mylopoulou, & Mimidis, 2010; Robaeys et al, 2006; Sasadeusz et al, 2011; Schaefer et al, 2003, 2007; Sylvestre, 2002; Sylvestre, Litwin, Clements, & Gourevitch, 2005; Van Thiel, Anantharaju, & Creech, 2003; Van Thiel et al, 1995; Waizmann & Ackermann, 2010; Wilkinson et al, 2009). International guidelines from the American Association for the Study of Liver Disease (AASLD)/Infectious Diseases Society of America (IDSA), the European Study for the Association of the Liver (EASL), the International Network for Hepatitis in Substance Users and the World Health Organization now all recommend treatment for HCV infection among PWID (AASLD/IDSA, 2015; European Association for Study of Liver, 2014; Robaeys et al, 2013; WHO, 2014).…”

“Hepatitis C treatment turned me around:” Psychological and behavioral transformation related to hepatitis C treatment

“…However, individuals with a history of substance use are less likely to have access to or engage in HCV treatment. Despite evidence that substance users do not significantly differ in HCV treatment adherence or sustained virologic response from non-substance using HCV patients, system-, provider- and individual-level barriers contribute to limitations in HCV treatment access, initiation, and engagement (Harris and Rhodes, 2013; Papadopoulos et al, 2010). …”