Hepatitis C testing and treatment among active drug users in Amsterdam: results from the DUTCH-C project.
BACKGROUND
Although hepatitis C virus (HCV) treatment has shown to be effective, uptake of treatment among active drug users is still low. The Drug Users Treatment for Chronic Hepatitis-C project aims to offer active drug users in Amsterdam HCV testing and treatment using a multidisciplinary approach.


METHODS
The study population comprises drug users participating in the Amsterdam Cohort Studies and drug users referred to the Drug Users Treatment for Chronic Hepatitis-C unit. Drug users were offered HCV testing and, if chronically infected, medical and psychiatric screening and HCV treatment. Various specialists collaborated to provide optimal care. We assessed test-uptake and treatment-uptake and outcomes.


RESULTS
Four hundred and ninety-seven Amsterdam Cohort Studies drug users were offered HCV testing: 449 out of 497 (90%) accepted. HCV antibodies were found in 267 out of 449 (60%): 183 out of 267 (69%) were HCV-viremic and 49 out of 183 (27%) were HIV-co-infected. Of the 134 HCV-monoinfected patients, 102 (76%) initiated additional medical screening and 44 started treatment by 1 July 2009. Sixty-two drug users referred from methadone clinics were also HCV-monoinfected, of whom 14 started treatment by 1 July 2009. In total 58 persons were treated: 16 (27%) with genotype 1 or 4, 42 (72%) with genotype 2 or 3. Eighty-four percent used methadone, 97% used drugs (heroin, cocaine or amphetamine) at least once in the 6 months before treatment, 19% were active injectors. Sixty-two percent used alcohol, 41% had psychiatric disease other than substance abuse. Of the 57 individuals with sufficient follow-up, 37 (65%) achieved sustained virological response.


CONCLUSIONS
In a multidisciplinary setting, HIV-negative drug users with chronic HCV infection can be treated successfully despite active drug or alcohol use and psychiatric diseases. Therefore, access to HCV therapy using an integrated approach should be increased for this population.
Department of Research, Cluster Infectious Diseases Public Health Service Amsterdam, The Netherlands.
Catharina E A
CE
Lindenburg
Femke A E
FA
Lambers
Anouk T
AT
Urbanus
Janke
J
Schinkel
Peter L M
PL
Jansen
Anneke
A
Krol
Gerty
G
Casteelen
Gerrit
G
van Santen
Charlotte H S B
CH
van den Berg
Roel A
RA
Coutinho
Maria
M
Prins
Christine J
CJ
Weegink
D000328:Adult; D000914:Antibodies, Viral / Q000097:blood / Q000276:immunology; D000998:Antiviral Agents / Q000627:therapeutic use; D015331:Cohort Studies; D015897:Comorbidity; D055030:Drug Users / Q000523:psychology / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000276:immunology; D016174:Hepacivirus / Q000187:drug effects / Q000276:immunology / Q000302:isolation & purification*; D019698:Hepatitis C, Chronic / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000276:immunology / Q000523:psychology; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000627:therapeutic use; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011092:Polyethylene Glycols / Q000627:therapeutic use; D011446:Prospective Studies; D011994:Recombinant Proteins; D012254:Ribavirin / Q000627:therapeutic use; D019966:Substance-Related Disorders / Q000453:epidemiology; D016896:Treatment Outcome
D000914:Antibodies, Viral; D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C417083:peginterferon alfa-2b; C100416:peginterferon alfa-2a