Treatment of Chronic Hepatitis C in Active Drug Users

Davis, Gary L.; Rodrigue, James R.

doi:10.1056/nejm200107193450312

Cited by 122 publications

(93 citation statements)

References 37 publications

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“…This is in line with the current discussion about treatment of HCV in active drug users. 6,34,35 Patients with former addiction had the highest dropout rate and mental instability, although severe psychiatric comorbidity was excluded. Time of abstinence, ranging from 3 months to several years, did not seem to influence the number of dropouts due to a drug relapse.…”

Section: Discussionmentioning

confidence: 99%

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

2003

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Chronic HCV infection is the leading cause of chronic liver disease, including cirrhosis and cancer, and the most common indication for liver transplantation. 3 Interferon alfa (IFN-␣) was the first effective treatment of this disease, and the combination with ribavirin increased sustained virologic response rates from 10% to more than 40%. 4,5 The most frequent routes of HCV infection are contaminated human blood products and needle-sharing by individuals with an intravenous drug addiction. 1 Between 36% and 95% of intravenous drug users are infected with HCV before 40 years of age, mostly with genotype 2 and 3. 6-8 Young age and genotype 2 or 3 are regarded as positive predictors of response to IFN-␣ therapy, 4 but former or current drug use as well as mental disorders are considered risk factors for IFN-␣-induced severe psychiatric side effects such as depression, suicidality, or relapse in drug use. [9][10][11][12] In particular, reports of suicide attempts during IFN-␣ therapy and the risk of reinfection led to the Abbreviations: HCV, hepatitis C virus; IFN, interferon; ALT, alanine aminotransferase. From the

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Section: Discussionmentioning

confidence: 99%

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

2003

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“…16 Recent articles in the New England Journal of Medicine argued in favor of treating HCV infection in select patients who are actively using illicit drugs. 20,21 The lack of clear guidelines regarding OLT in patients on MMT is confounded further by the considerable social stigma attached to a patient on chronic methadone treatment. Patients on MMT, despite having documented abstinence from illicit drug use, may be perceived as having settled into a drug-dependent lifestyle with little motivation to change.…”

Section: Discussionmentioning

confidence: 99%

Liver transplantation for patients on methadone maintenance

Kanchana

Kaul

Manzarbeitia

et al. 2002

Liver Transplantation

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Most transplant programs require abstinence of at least 6 months from alcohol and illicit drugs before orthotopic liver transplantation (OLT). However, there are no published data regarding OLT outcomes in patients who are currently on methadone maintenance treatment (MMT) as part of the treatment of their heroin addiction at the time of OLT. The objective of this study is to evaluate our experience regarding the outcome of OLT in patients with end-stage liver disease (ESLD) who were on MMT at the time of OLT. Between March 1993 and May 1999, a total of 185 patients with ESLD underwent OLT at our center. Five transplant recipients (2.7%) had a history of heroin abuse and had undergone drug and alcohol rehabilitation, but could not be weaned off methadone. Pre-OLT status, drug history, perioperative course, compliance with medical therapy, post-OLT follow-up, and patient and allograft survival were analyzed in detail in these patients. All patients on MMT underwent uneventful OLTs. Their compliance with medications and follow-up was excellent. One patient was weaned completely off methadone after OLT. Post-OLT mean hospital stay in this group was 43 ؎ 25 days. Although the number of patients was small, long-term outcome of liver transplant recipients on MMT appears similar to that of patients not on MMT who underwent OLT during this period. Our results suggest cirrhotic patients on MMT should be considered for OLT if they meet the same psychosocial requirements as patients with alcohol abuse. Furthermore, it is not necessary for patients to be weaned off methadone before OLT. O rthotopic liver transplantation (OLT) is well established as an effective treatment for patients with end-stage liver disease (ESLD). One of the major challenges currently facing OLT is that the number of candidates far exceeds available organs. As of May 2000, a total of 15,258 patients were on waiting lists. Hepatitis C is the leading cause for OLT, followed by alcoholic liver disease; both are primarily substance abuse-related diagnoses. 1,2 Recipient selection is a critical aspect of OLT and involves a multidisciplinary approach. 3,4 Patients undergo an extensive psychosocial evaluation in addition to medical evaluation. Currently, patients actively using illicit drugs are excluded from consideration for OLT. 3-5 Methadone maintenance treatment (MMT) is routinely prescribed for patients during and after rehabilitation from heroin use. Patients on MMT appear to fare better with respect to social functioning, job rates, lower imprisonment, and human immunodeficiency virus infection compared with patients denied methadone after rehabilitation from heroin use. 6,7 Although patients fully rehabilitated from previous drug use are considered OLT candidates, there is a paucity of data regarding OLT in patients administered methadone at the time of OLT as part of MMT.Only 56% of transplant programs accept patients on MMT for OLT, and 32% of programs require discontinuation of MMT before OLT. 8 This apparent discrimination against patients on MM...

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“…Treatment for HCV in IDUs should be initiated through an individualized approach, 118 as for all HCV infected people, 112 and there should be no automatic or implicit exclusion of IDUs from treatment. 135 Important principles to consider in the operationalization of treatment are the need for effective access and support and a trusting provider environment.…”

Section: How Would Hepatitis C Virus Treatment Best Be Delivered To Imentioning

confidence: 99%

Injection Drug Use and the Hepatitis C Virus: Considerations for a Targeted Treatment Approach--The Case Study of Canada

Fischer

Haydon

Rehm

et al. 2004

Journal of Urban Health: Bulletin of the New York Academy of Me

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Treatment of Chronic Hepatitis C in Active Drug Users

Cited by 122 publications

References 37 publications

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

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

Liver transplantation for patients on methadone maintenance

Injection Drug Use and the Hepatitis C Virus: Considerations for a Targeted Treatment Approach--The Case Study of Canada

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