Case series on the safe use of buprenorphine/naloxone in individuals with acute hepatitis C infection and abnormal hepatic liver transaminases.
BACKGROUND
Hepatitis C virus (HCV) is the most prevalent chronic viral illness in the United States. Many individuals with virus HCV are opioid dependent requiring treatment with opiate substitution treatment such as buprenorphine. Previous reports in the literature have suggested hepatotoxicity with buprenorphine tempering initial enthusiasm of the safety of buprenorphine in HCV-infected patients.


METHODS
As part of an ongoing SAMHSA-funded grant to expand opiate substitution therapy with buprenorphine, all opioid-dependent patients seeking treatment with buprenorphine undergo a laboratory evaluation including transaminases (AST/ALT) as well as laboratory evaluation for acute and chronic hepatitis.


RESULTS
Of the 121 patients screened for entry into buprenorphine treatment, 4 patients had evidence of acute HCV infection.


CONCLUSIONS
Despite markedly elevated transaminases in the setting of acute hepatitis C infection, these patients tolerated buprenorphine treatment with improvement in their transaminases during the course of buprenorphine treatment.
Bruce
Robert D
RD
Yale University AIDS Program, New Haven, Connecticut 06511, USA. robert.bruce@yale.edu
Altice
Frederick L
FL
D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D001714:Bipolar Disorder / Q000150:complications; D002047:Buprenorphine / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*; D019970:Cocaine-Related Disorders / Q000150:complications; D005260:Female; D006515:Hepatitis B virus / Q000737:chemistry; D006526:Hepatitis C / Q000150:complications* / Q000201:enzymology*; D006801:Humans; D008099:Liver / Q000201:enzymology*; D008111:Liver Function Tests; D008297:Male; D009270:Naloxone / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*; D016485:Needle Sharing; D009293:Opioid-Related Disorders / Q000150:complications / Q000534:rehabilitation*; D012367:RNA, Viral / Q000097:blood; D000637:Transaminases / Q000378:metabolism*
D009292:Narcotic Antagonists; D012367:RNA, Viral; D009270:Naloxone; D002047:Buprenorphine; D000637:Transaminases; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase