title: Patients receiving opioid maintenance treatment in primary care: successful chronic hepatitis C care in a real world setting.
abstract: BACKGROUND
  Injection drug users (IDUs) represent a significant proportion of patients with chronic hepatitis C (CHC). The low treatment uptake among these patients results in a low treatment effectiveness and a limited public health impact. We hypothesised that a general practitioner (GP) providing an opioid maintenance treatment (OMT) for addicted patients can achieve CHC treatment and sustained virological response rates (SVR) comparable to patients without drug dependency.
  
  
  METHODS
  Retrospective patient record analysis of 85 CHC patients who received OMT for more than 3 months in a single-handed general practice in Zurich from January 1, 2002 through May 31, 2008. CHC treatment was based on a combination with pegylated interferon and ribavirin. Treatment uptake and SVR (undetectable HCV RNA 6 months after end of treatment) were assessed. The association between treatment uptake and patient characteristics was investigated by multiple logistic regression.
  
  
  RESULTS
  In 35 out of 85 CHC patients (52 males) with a median (IQR) age of 38.8 (35.0-44.4) years, antiviral therapy was started (41.2%). Median duration (IQR) of OMT in the treatment group was 55.0 (35.0-110.1) months compared to the group without therapy 24.0 (9.8-46.3) months (p<0.001). OMT duration remained a significant determinant for treatment uptake when controlled for potential confounding. SVR was achieved in 25 out of 35 patients (71%).
  
  
  CONCLUSIONS
  In addicted patients a high CHC treatment and viral eradication rate in a primary care setting in Switzerland is feasible. Opioid substitution seems a beneficial framework for CHC care in this "difficult to treat" population.
authors.affiliation: Institute of General Practice and Health Services Research, University of Zurich, Zurich, Switzerland.
authors.forename: André
authors.initials: A
authors.lastname: Seidenberg
authors.forename: Thomas
authors.initials: T
authors.lastname: Rosemann
authors.forename: Oliver
authors.initials: O
authors.lastname: Senn
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use*; D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D005838:Genotype; D016174:Hepacivirus / Q000235:genetics; D019698:Hepatitis C, Chronic / Q000188:drug therapy / Q000209:etiology* / Q000821:virology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019966:Substance-Related Disorders / Q000150:complications* / Q000188:drug therapy*; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D000701:Analgesics, Opioid; D000998:Antiviral Agents