title: Access to care of patients with chronic hepatitis C virus infection in a university hospital: Is opioid dependence a limiting condition?
abstract: BACKGROUND
  We aimed to examine access to care of opioid-dependent patients with chronic hepatitis C.
  
  
  METHODS
  A standardized form was used to conduct a retrospective survey from 1999 to 2003 in a French university hospital. All HCV RNA positive in- or outpatients who had not had a liver biopsy or anti-HCV treatment were included. Opioid-dependence was defined as active opioid drug use or being on opioid substitution treatment.
  
  
  RESULTS
  The survey included 580 patients; 137 (23.6%) were opioid-dependent. Fewer patients with than without current opioid dependence had had genotyping (40.1% versus 67.7%, p<0.001), liver biopsy (51.8% versus 62.8%, p=0.022), and anti-HCV treatment (8.8% versus 18.3%, p=0.008). Genotyping was independently, negatively, associated with: (1) current opioid-dependence (OR=0.3, 95%CI=0.2-0.5), (2) former opioid-dependence (OR=0.5, 95%CI=0.3-0.9), (3) unemployment (OR=0.5, 95%CI=0.3-0.7), and (4) HCV infection discovered by screening (OR=0.5, 95%CI=0.3-0.7). Access to liver biopsy was independently, negatively associated with current opioid-dependence (OR=0.6, 95%CI=0.4-0.9), but positively associated with alcohol consumption (OR=2.0, 95%CI=1.2-3.4) and abnormal ALT level (OR=2.2, 95%CI=1.5-3.2). Access to anti-HCV treatment was independently, negatively associated with HCV infection discovered by screening (OR=0.5, 95%CI=0.3-0.9), but positively associated with moderate hepatitis (OR=6.8, 95%CI=2.8-16.8), extensive fibrosis or cirrhosis (OR=12.3, 95%CI=5.5-27.5), abnormal ALT level (OR=2.1, 95%CI=1.3-3.6) and age (40-64 years) (OR=1.9, 95%CI=1.0-3.4).
  
  
  CONCLUSIONS
  Genotyping and liver biopsies were performed less frequently on current opioid dependent patients. Absence of genotyping was also independently associated with unemployment and former opioid-dependence. Alcohol consumption or abnormal ALT levels favored access to biopsy. Histological grade strongly conditioned access to anti-HCV treatment.
authors.affiliation: Risk Management and Quality Unit, AP-HP, Hôpital Cochin, 75014 Paris, France. gwenaelle.vidal-trecan@univ-paris5.fr
authors.forename: Valerie
authors.initials: V
authors.lastname: Perut
authors.forename: Celine
authors.initials: C
authors.lastname: Labalette
authors.forename: Philippe
authors.initials: P
authors.lastname: Sogni
authors.forename: Isabelle
authors.initials: I
authors.lastname: Ferrand
authors.forename: Dominique
authors.initials: D
authors.lastname: Salmon-Céron
authors.forename: Gwenaelle
authors.initials: G
authors.lastname: Vidal-Trecan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000998:Antiviral Agents / Q000627:therapeutic use; D005260:Female; D005838:Genotype; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D019698:Hepatitis C, Chronic / Q000150:complications / Q000453:epidemiology* / Q000628:therapy*; D006785:Hospitals, University / Q000706:statistics & numerical data*; D006801:Humans; D008099:Liver / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000150:complications / Q000453:epidemiology*; D010297:Paris / Q000453:epidemiology; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D055815:Young Adult
chemical_list: D000998:Antiviral Agents