Effectiveness of chronic hepatitis C treatment in drug users in routine clinical practice: results of a prospective cohort study.
OBJECTIVE
Injection drug users are often excluded from hepatitis C virus (HCV) treatment. This study compares sustained virological response, adherence, and quality of life in patients with or without a history of illicit drug use in routine clinical practice.


METHODS
This is a post-hoc analysis of a prospective, observational study conducted in 1860 patients who received peginterferon alpha-2b/ribavirin combination therapy. Nondrug users (NDUs) were defined as patients without a history of drug addiction; former drug users (FDUs) as patients who had stopped using illicit drugs or opioid maintenance therapy and active drug users (ADUs) as patients using illicit drugs or on opioid maintenance therapy. Virological response, adherence, and the health-related quality of life were assessed by the measure of HCV RNA in the serum, self-report and 36-item short-form health survey Questionnaire, respectively.


RESULTS
The analyzed population included 1038 (56%) NDUs, 578 (31%) FDUs, and 244 (13%) ADUs. About 85% of ADUs were on opioid maintenance therapy and 25% used illicit drugs. Although ADUs had a more chaotic lifestyle and more psychiatric disorders, sustained virological response of ADUs (58%) did not differ from that of NDUs (49%) and FDUs (51%) (P=0.133). Adherence rates were 39% in NDUs and FDUs, and 37% in ADUs (P=0.883). Health-related quality of life was improved in the three groups after the end of treatment.


CONCLUSIONS
Our study suggests that HCV therapy in ADUs on opioid maintenance therapy is as effective as in other HCV patients. The effectiveness of HCV therapy in illicit drug users needs to be evaluated in further studies.
Melin
Pascal
P
Department of Polyvalent Medicine, Hospital of Saint Dizier, Saint-Dizier, France. pascalmelin@hotmail.fr
Chousterman
Michel
M
Fontanges
Thierry
T
Ouzan
Denis
D
Rotily
Michel
M
Lang
Jean-Philippe
JP
Marcellin
Patrick
P
Cacoub
Patrice
P
D000701:Analgesics, Opioid / Q000008:administration & dosage; D000998:Antiviral Agents / Q000008:administration & dosage*; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000188:drug therapy*; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000008:administration & dosage*; D055118:Medication Adherence; D011092:Polyethylene Glycols / Q000008:administration & dosage*; D011446:Prospective Studies; D011788:Quality of Life; D011994:Recombinant Proteins; D012254:Ribavirin / Q000008:administration & dosage*; D019966:Substance-Related Disorders / Q000150:complications* / Q000188:drug therapy; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C417083:peginterferon alfa-2b