title: Substitution treatment or active intravenous drug use should not be contraindications for antiviral treatment in drug users with chronic hepatitis C.
abstract: OBJECTIVE
  International guidelines and routine clinical practice express concerns about antiviral treatment in intravenous drug users (IDUs). We analysed the effect of IDU and/or substitution therapy on chronic hepatitis C (CHC) treatment adherence and response.
  
  
  METHODS
  Intravenous drug users with CHC were divided into three groups: (A) patients on a substitution programme; (B) active users; and (C) past IDUs. Patients were treated according to the standard of care and followed by a specialist team.
  
  
  RESULTS
  A total of 175 patients (mean age 39.4±8.8) were included. One hundred and forty-four (65%) were adherent to therapy (completing treatment and 6 months of follow-up). Twenty-two patients (36%) discontinued because of side effects, 28 (46%) discontinued on their own and 11 (18%) completed treatment but did not present at follow-up. Of 142 patients with available treatment outcome, 99 (69.7%) achieved a sustained virological response (SVR), with no differences among the study groups. Patients with genotypes 2-3 and those who completed the treatment schedule had 2.78-fold (95% CI: 1.3-5.8) and 6.4-fold (95% CI: 2.6-15.6) higher probability of achieving SVR.
  
  
  CONCLUSIONS
  Active use of illicit drugs and/or drug substitution do not affect the treatment outcome in patients with CHC as long as they are closely followed and remain adherent to the treatment.
authors.affiliation: 2nd Academic Department of Internal Medicine, Hippokration General Hospital, Agia Paraskevi, Athens, Greece. smanolak@med.uoa.gr
authors.forename: Spilios
authors.initials: S
authors.lastname: Manolakopoulos
authors.forename: Melanie J
authors.initials: MJ
authors.lastname: Deutsch
authors.forename: Olga
authors.initials: O
authors.lastname: Anagnostou
authors.forename: Stelios
authors.initials: S
authors.lastname: Karatapanis
authors.forename: Elli
authors.initials: E
authors.lastname: Tiniakou
authors.forename: George V
authors.initials: GV
authors.lastname: Papatheodoridis
authors.forename: Ekaterini
authors.initials: E
authors.lastname: Georgiou
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Manesis
authors.forename: Dimitris
authors.initials: D
authors.lastname: Tzourmakliotis
authors.forename: Athanasios J
authors.initials: AJ
authors.lastname: Archimandritis
mesh_terms: D000293:Adolescent; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D000075202:Contraindications; D004359:Drug Therapy, Combination; D055030:Drug Users; D005260:Female; D005838:Genotype; D006115:Greece; D016174:Hepacivirus / Q000235:genetics; D019698:Hepatitis C, Chronic / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D007372:Interferons / Q000627:therapeutic use*; D016015:Logistic Models; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D016017:Odds Ratio; D012367:RNA, Viral / Q000097:blood; D012189:Retrospective Studies; D012254:Ribavirin / Q000627:therapeutic use*; D018570:Risk Assessment; D012307:Risk Factors; D015819:Substance Abuse, Intravenous / Q000150:complications* / Q000534:rehabilitation*; D013997:Time Factors; D016896:Treatment Outcome; D019562:Viral Load; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D012367:RNA, Viral; D012254:Ribavirin; D007372:Interferons