[Hepatitis C virus screening in drug users in an addiction out-patient unit].
OBJECTIVE
To investigate the feasibility and efficacy of hepatitis C virus screening in drug users in an addiction out-patient unit.


METHODS
All patients followed in an addiction out-patient unit were asked to undergo anti-hepatitis C virus antibody testing; further evaluation and treatment if indicated, were offered to positive patients. When treatment was initiated (Metavir score >=F2), patients were followed-up both by the hepatologist and the out-patient unit physician.


RESULTS
Between July 1997 and September 2000, 404 consecutive patients (310 men, mean age: 32, alcohol intake >=50 g per day in 51%, 94% in opiate substitution program) were included. Sixty-six per cent (269/404) of patients agreed to undergo HCV antibodies testing: 84% had a positive test. 68% of these patients accepted ALT serum measurement and 120 had indications for liver biopsy. Eighty-eight liver biopsies were performed, showing severe fibrosis (Metavir score F3 or F4) in 20 cases (22%). Ethanol intake was significantly correlated to fibrosis (P<0.05). Antiviral treatment was indicated in 47 patients but was only initiated in 27 due to patient refusal (n=7) or contraindication (n=13). Treatment had to be discontinued in 12 cases because of psychiatric side effects (depression: n=3; delirium: n=3; severe irritability: n=3; relapse with heroin injection: n=3). Finally, only 5 patients were sustained responders.


CONCLUSIONS
Despite the high seroprevalence of HCV antibodies in this unit, the benefits of antiviral therapy are low due to high drop out rate. Ethanol withdrawal should be the highest priority in these patients.
Grando-Lemaire
Véronique
V
Service d'Hépato-Gastroentérologie, Hôpital Jean Verdier, Assistance publique-Hôpitaux de Paris, 93143 Bondy Cedex, France. veronique.grando@jvr.ap-hop-paris.fr
Goisset
Pierre
P
Sorge
Frédéric
F
Trinchet
Jean-Claude
JC
Castera
Laurent
L
Roulot
Dominique
D
Sitruk
Véronique
V
Beaugrand
Michel
M
D000328:Adult; D000553:Ambulatory Care; D000998:Antiviral Agents / Q000627:therapeutic use; D005240:Feasibility Studies; D005260:Female; D005602:France; D015438:Health Behavior; D006526:Hepatitis C / Q000097:blood* / Q000188:drug therapy / Q000523:psychology; D018937:Hepatitis C Antibodies / Q000097:blood*; D006801:Humans; D007372:Interferons / Q000627:therapeutic use; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016036:Seroepidemiologic Studies; D019966:Substance-Related Disorders / Q000097:blood* / Q000821:virology
D000998:Antiviral Agents; D018937:Hepatitis C Antibodies; D007372:Interferons