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

Novick, David M.; Kreek, Mary Jeanne

doi:10.1111/j.1360-0443.2008.02188.x

Cited by 86 publications

(81 citation statements)

References 147 publications

(228 reference statements)

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“…The length of HCV treatment is 24 weeks for Genotypes 2 and 3 and 48 weeks for Genotype 1 (Novick and Kreek, 2008;Ostapowicz et al, 1999). Hence we assume an average length of treatment of 36 weeks.…”

Section: Parameter Estimationmentioning

confidence: 99%

“…This leads to the rate of those failing HCV treatment of 52/18 per year and the rate for is 52/36 per year. The probability of success of HCV treatment is approximately 50% (Novick and Kreek, 2008).…”

Section: Parameter Estimationmentioning

confidence: 99%

“…There is some debate about whether MMT increases compliance with HCV treatment (Ebner et al, 2009;Novick and Kreek, 2008;Treloar and Fraser, in press). Therefore, if we assume that those not in MMT are less adherent to HCVtreatment resulting in lower probability of success for this group ( ), then the optimal allocation point shifts to favour those in MMT.…”

Section: The Two Group Model: the Impact Of Mmtmentioning

confidence: 99%

“…Between 70% and 90% of acute HCV cases progress to chronic infection (Guidotti and Chisari, 2006). For those who receive treatment with pegylated interferon and ribavirin, approximately 50% will remain undetectable for HCV RNA 6 months post therapy (Novick and Kreek, 2008). However, HCV treatment is unpleasant and not necessarily well tolerated (Novick and Kreek, 2008).…”

Section: Introductionmentioning

confidence: 99%

“…For those who receive treatment with pegylated interferon and ribavirin, approximately 50% will remain undetectable for HCV RNA 6 months post therapy (Novick and Kreek, 2008). However, HCV treatment is unpleasant and not necessarily well tolerated (Novick and Kreek, 2008). Moreover continued injecting behaviour places the user at risk of reinfection even if they successfully complete treatment (Aitken et al, 2008b).…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Optimal targeting of Hepatitis C virus treatment among injecting drug users to those not enrolled in methadone maintenance programs

Zeiler

Langlands

Murray

et al. 2010

Drug and Alcohol Dependence

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Background: This work used mathematical modelling to explore effective policy for hepatitis C virus (HCV) treatment in Australia in the context of methadone maintenance treatment (MMT).Method: We consider two models to depict HCV in the population of injecting drug users (IDU) within Australia. The first model considers the IDU population as a whole. The second model includes separate components for those that are or are not enrolled in MMT. The impact of different levels of HCV treatment and its allocation dependent on MMT status were then determined in terms of the steady state levels of each of these models.Results: Although increasing levels of HCV treatment decrease chronic infection prevalence, initially numbers of acutely infected can rise. This is caused by the high rate of reinfection. We find that no matter the extent of HCV treatment, HCV prevalence cannot be eliminated without limiting risk behaviour. Assuming equal adherence to HCV therapy between MMT and non-MMT, over 84% of HCV treatment should be allocated to those not in MMT. Only if adherence to HCV therapy in non MMT patients falls below 44% of that in MMT then treatment should be preferentially directed to those in MMT.Conclusions: Contrary to generally held beliefs regarding HCV treatment the majority of therapy should be allocated to those that are still actively injecting. This is due to rates of reinfection and to the high turnover of individuals in MMT. Higher adherence to HCV therapy in MMT would need to be achieved before this changed.

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Section: Parameter Estimationmentioning

confidence: 99%

Section: Parameter Estimationmentioning

confidence: 99%

Section: The Two Group Model: the Impact Of Mmtmentioning

confidence: 99%