title: Management of hepatitis C virus (HCV) infection in drug substitution programs.
abstract: BACKGROUND
  In Switzerland, intravenous drug use (IDU) accounts for 80% of newly acquired hepatitis C virus (HCV) infections. Early HCV treatment has the potential to interrupt the transmission chain and reduce morbidity/mortality due to decompensated liver cirrhosis and hepatocellular carcinoma. Nevertheless, patients in drug substitution programs are often insufficiently screened and treated.
  
  
  OBJECTIVE
  With the aim to improve HCV management in IDUs, we conducted a cross sectional chart review in three opioid substitution programs in St. Gallen (125 methadone and 71 heroin recipients). Results were compared with another heroin substitution program in Bern (202 patients) and SCCS/SHCS data.
  
  
  RESULTS
  Among the methadone/heroin recipients in St. Gallen, diagnostic workup of HCV was better than expected: HCV/HIV-status was unknown in only 1% (2/196), HCV RNA was not performed in 9% (13/146) of anti-HCV-positives and the genotype missing in 15% (12/78) of HCV RNA-positives. In those without spontaneous clearance (two thirds), HCV treatment uptake was 23% (21/91) (HIV-: 29% (20/68), HIV+: 4% (1/23)), which was lower than in methadone/heroin recipients and particularly non-IDUs within the SCCS/SHCS, but higher than in the, mainly psychiatrically focussed, heroin substitution program in Bern (8%). Sustained virological response (SVR) rates were comparable in all settings (overall: 50%, genotype 1: 35-40%, genotype 3: two thirds). In St. Gallen, the median delay from the estimated date of infection (IDU start) to first diagnosis was 10 years and to treatment was another 7.5 years.
  
  
  CONCLUSIONS
  Future efforts need to focus on earlier HCV diagnosis and improvement of treatment uptake among patients in drug substitution programs, particularly if patients are HIV-co-infected. New potent drugs might facilitate the decision to initiate treatment.
authors.affiliation: Department of Infectious Diseases, Cantonal Hospital St. Gallen, 9007 St. Gallen, Switzerland. andrea.witteck@kssg.ch
authors.forename: Andrea
authors.initials: A
authors.lastname: Witteck
authors.forename: Patrick
authors.initials: P
authors.lastname: Schmid
authors.forename: Katharina
authors.initials: K
authors.lastname: Hensel-Koch
authors.forename: Maria C
authors.initials: MC
authors.lastname: Thurnheer
authors.forename: Philip
authors.initials: P
authors.lastname: Bruggmann
authors.forename: Pietro
authors.initials: P
authors.lastname: Vernazza
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis / Q000706:statistics & numerical data; D005260:Female; D005838:Genotype; D015658:HIV Infections / Q000150:complications; D016174:Hepacivirus / Q000235:genetics; D006526:Hepatitis C / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data; D012367:RNA, Viral / Q000097:blood; D012189:Retrospective Studies; D016320:Substance Abuse Treatment Centers / Q000706:statistics & numerical data; D019966:Substance-Related Disorders / Q000150:complications*; D013557:Switzerland; D013997:Time Factors; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D012367:RNA, Viral