title: Hepatitis C virus eradication in intravenous drug users maintained with subcutaneous naltrexone implants.
abstract: The effectiveness of HCV antiviral therapy in patients who have undergone recent drug dependency treatment and continue to inject drugs sporadically is presently not clear. Patients attending a community-based drug rehabilitation and naltrexone implant clinic from October 2002 until March 2005 were screened for HCV infection and if positive offered further assessment and treatment with interferon and ribavirin therapy. The first 50 patients to commence HCV therapy and complete at least 6 months follow-up were prospectively studied. ETR response (HCV PCR negative) was 34/50 (68%) and SVR 6 months post-treatment was 31/50 (62%). Viral eradication was maintained in those 22 patients that have had 12 months or more post-treatment follow-up. Eleven (22%) patients stopped therapy early due to side effects or poor compliance. Only two patients with an ETR likely reinfected due to unsafe injection practices. One was re-treated and achieved an SVR. Of the patients achieving a 6-month SVR, 17 of 31 patients reported no further IDU and 13 of 31 patients occasional IDU during treatment and this was maintained after HCV treatment cessation. 46% of patients received antidepressant and/or antipsychotic medication during treatment.
  
  
  CONCLUSIONS
  This study of HCV treatment in a community-based subcutaneous naltrexone implant clinic found antiviral therapy resulted in a 62% SVR. This result is comparable to that reported in hospital-based clinics in non-IDU patients. The side effect profile and compliance was also similar. HCV antiviral therapy should be offered to this large and currently under treated group.
authors.affiliation: School of Medicine and Pharmacology, The University of Western Australia, Perth, Western Australia, Australia. gjeffrey@cyllene.uwa.edu.au
authors.forename: Gary P
authors.initials: GP
authors.lastname: Jeffrey
authors.forename: Gerry
authors.initials: G
authors.lastname: MacQuillan
authors.forename: Fern
authors.initials: F
authors.lastname: Chua
authors.forename: Sam
authors.initials: S
authors.lastname: Galhenage
authors.forename: Judith
authors.initials: J
authors.lastname: Bull
authors.forename: Emma
authors.initials: E
authors.lastname: Young
authors.forename: Gary
authors.initials: G
authors.lastname: Hulse
authors.forename: George
authors.initials: G
authors.lastname: O'Neil
mesh_terms: D000293:Adolescent; D000328:Adult; D000998:Antiviral Agents / Q000494:pharmacology / Q000627:therapeutic use*; D004343:Drug Implants; D005260:Female; D016174:Hepacivirus / Q000187:drug effects; D006526:Hepatitis C / Q000188:drug therapy* / Q000635:transmission; D006801:Humans; D016898:Interferon-alpha / Q000494:pharmacology / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009271:Naltrexone / Q000008:administration & dosage / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D010349:Patient Compliance; D011446:Prospective Studies; D012254:Ribavirin / Q000494:pharmacology / Q000627:therapeutic use*; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000534:rehabilitation* / Q000821:virology; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D004343:Drug Implants; D016898:Interferon-alpha; D009292:Narcotic Antagonists; D012254:Ribavirin; D009271:Naltrexone