title: The impact of lifetime drug use on hepatitis C treatment outcomes in insured members of an integrated health care plan.
abstract: BACKGROUND
  The relation of drug use to HCV treatment outcome in an insured household population has not been previously reported.
  
  
  METHODS
  Lifetime frequencies of marijuana use and non-medical use of stimulants, sedatives, and opioids; hallucinogens; and inhalants were retrospectively assessed in 259 privately insured members of an integrated health care plan treated for chronic hepatitis C virus infection (HCV+) with pegylated interferon alpha and ribavirin and examined with respect to rates of sustained virological response (SVR).
  
  
  RESULTS
  The majority of patients reported chronic use of multiple illegal drugs; 61.6% reported injection drug use (IDU); 79.5% abstained from drug use during the six months prior to HCV treatment. Total frequency of individual drugs, multiple drugs, and length of abstention from drugs prior to HCV treatment were not related to impaired SVR rates. Sustained viral responses were obtained in 80.2% of patients with HCV genotype 2/3 and 45.1% of patients with genotype 1/4/6. Marijuana use during HCV treatment, reported by 8.5% of patients, was associated with higher treatment adherence (95.5% compared with 78.9%, p=0.045), but lower SVR rates (40.9% compared with 62.5%, p=0.041). In addition, drug use during HCV treatment was associated with significantly higher relapse rates, 18.8% compared with 7.7% (p=0.053).
  
  
  CONCLUSIONS
  A history of chronic illegal drug use should not be considered a deterrent to HCV treatment in members of an integrated health care plan who are motivated to seek treatment and closely monitored, but drug use during HCV treatment, including marijuana use, should be discouraged.
authors.affiliation: Prevention Research Center, 1995 University Avenue, Suite 450, Berkeley, CA 94704, United States. Electronic address: russell@prev.org.
authors.forename: Marcia
authors.initials: M
authors.lastname: Russell
authors.affiliation: Department of Gastroenterology and Hepatology, Kaiser Permanente North Valley Medical Center, 2025 Morse Avenue, Sacramento, CA 95825, United States.
authors.forename: Mary Patricia
authors.initials: MP
authors.lastname: Pauly
authors.affiliation: Kaiser Permanente Health Plan, Chemical Dependency Recovery Program, 2829 Watt Avenue, Suite 150, Sacramento, CA 95821, United States.
authors.forename: Charles Denton
authors.initials: CD
authors.lastname: Moore
authors.affiliation: Kaiser Permanente Health Plan, Chemical Dependency Recovery Program, 2829 Watt Avenue, Suite 150, Sacramento, CA 95821, United States.
authors.forename: Constance
authors.initials: C
authors.lastname: Chia
authors.affiliation: Kaiser Permanente Health Plan, Chemical Dependency Recovery Program, 2829 Watt Avenue, Suite 150, Sacramento, CA 95821, United States.
authors.forename: Jennifer Mary
authors.initials: JM
authors.lastname: Dorrell
authors.affiliation: Department of Gastroenterology and Hepatology, Kaiser Permanente North Valley Medical Center, 2025 Morse Avenue, Sacramento, CA 95825, United States.
authors.forename: Renee Junko
authors.initials: RJ
authors.lastname: Cunanan
authors.affiliation: Department of Gastroenterology and Hepatology, Kaiser Permanente North Valley Medical Center, 2025 Morse Avenue, Sacramento, CA 95825, United States.
authors.forename: Gayle
authors.initials: G
authors.lastname: Witt
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D015331:Cohort Studies; D019033:Delivery of Health Care, Integrated / Q000639:trends*; D005260:Female; D019698:Hepatitis C, Chronic / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D006801:Humans; D007348:Insurance, Health / Q000639:trends*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018434:Sickness Impact Profile; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents
keywords: Hepatitis C; Intravenous drug use; Lifetime drug use; Marijuana; Retrospective cohort study