title: Addicts with chronic hepatitis C: difficult to reach, manage or treat?
abstract: OBJECTIVE
  To assess the acceptance, safety and efficacy of care and treatment for chronic hepatitis C (CHC) in drug addicts.
  
  
  METHODS
  We designed a multidisciplinary, phase IV prospective cohort study. All illicit drug users (IDUs) visited a Territorial Addiction Service (SerT) in the District of Brescia, and hepatitis C antibody (HCVAb) testing positive were offered as part of a standardised hepatologic visit in our Gastroenterology Unit. Patients with confirmed CHC and without medical contraindications were administered peginterferon alfa-2b 1.5 μg/kg per week plus ribavirin (800-1400 mg/d) for 16-48 wk. All IDUs were unselected because of ongoing addiction and read and signed an informed consent form. Virologic responses at weeks 4 and 12 of therapy, at the end of treatment and 24 wk after the end of treatment were the main measures of efficacy. Adherence was estimated according to the 80/80/80 criteria.
  
  
  RESULTS
  From November 2007 to December 2009, 162 HCVAb+ IDUs were identified. Sixty-seven patients (41% of the initial cohort) completed the diagnostic procedure, and CHC was diagnosed in 54 (33% of the total). Forty-nine patients were offered therapy, and 39 agreed (80% of acceptance rate). The prevalent HCV genotype was type 1, and the HCV RNA baseline level was over 5.6 log/mL in 61% of cases. Five patients dropped out, two because of severe adverse events (SAEs) and three without medical need. Twenty-three and 14 patients achieved end of treatment responses (ETRs; 59%) and sustained virologic responses (SVRs; 36%), respectively. Thirty-one patients were fully compliant with the study protocol (80% adherence). The prevalence of host and viral characteristics negatively affecting the treatment response was high: age over 40 years (54%), male gender (85%), overweight body type (36%), previous unsuccessful antiviral therapy (21%), HCV genotype and viral load (60% and 62%, respectively), earlier contact with HBV (40%) and steatosis and fibrosis (44% and 17%, respectively). In a univariate analysis, alcohol intake was associated with a non-response (P = 0.0018, 95%CI: 0.0058-0.4565).
  
  
  CONCLUSIONS
  Drug addicts with CHC can be successfully treated in a multidisciplinary setting using standard antiviral combination therapy, despite several "difficult to reach, manage and treat" characteristics.
authors.affiliation: Barbara Zanini, Federica Benini, Marie Graciella Pigozzi, Alberto Lanzini, Department of Clinical and Experimental Sciences, Gastroenterology Unit, University and Spedali Civili of Brescia, I-25123 Brescia, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Zanini
authors.forename: Federica
authors.initials: F
authors.lastname: Benini
authors.forename: Marie Graciella
authors.initials: MG
authors.lastname: Pigozzi
authors.forename: Patrizia
authors.initials: P
authors.lastname: Furba
authors.forename: Ernesto
authors.initials: E
authors.lastname: Giacò
authors.forename: Antonia
authors.initials: A
authors.lastname: Cinquegrana
authors.forename: Mariagrazia
authors.initials: M
authors.lastname: Fasoli
authors.forename: Alberto
authors.initials: A
authors.lastname: Lanzini
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003299:Cooperative Behavior; D004359:Drug Therapy, Combination; D055030:Drug Users; D005260:Female; D006297:Health Services Accessibility; D019698:Hepatitis C, Chronic / Q000175:diagnosis / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D033183:Interdisciplinary Communication; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000009:adverse effects / Q000627:therapeutic use*; D007558:Italy; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010348:Patient Care Team; D010352:Patient Dropouts; D011092:Polyethylene Glycols / Q000009:adverse effects / Q000627:therapeutic use*; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000009:adverse effects / Q000627:therapeutic use; D012254:Ribavirin / Q000009:adverse effects / Q000627:therapeutic use*; D012307:Risk Factors; D015819:Substance Abuse, Intravenous / Q000150:complications*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C417083:peginterferon alfa-2b
keywords: Addiction; Antiviral therapy; Chronic hepatitis C; Interferon; Multidisciplinary