title: Treatment for chronic hepatitis C in a cohort of opiate substitution therapy recipients in three Swedish cities - completion rates and efficacy.
abstract: OBJECTIVE
  Opiate substitution treatment (OST) programs could provide opportunities for management of comorbidities, such as hepatitis C virus (HCV) infection, in people who inject drugs. We aimed to prospectively evaluate the real-life feasibility of interferon/ribavirin-based HCV treatment in OST recipients, with a special focus on psychiatric status and health-related quality of life.
  
  
  METHODS
  Patients from a cohort of OST recipients from three cities in Sweden were selected for HCV treatment on the basis of structured investigation for HCV-related liver disease. Therapy was delivered in collaboration between infectious disease and OST clinics, with monitoring for completion and adherence, treatment response, adverse events, health-related quality of life (HRQoL) (SF-36) and signs of depression (MADRS-S), or relapse into drug abuse. The primary endpoint was completion of prescribed treatment; the secondary endpoints were sustained virological response (SVR), adherence, and incidence of depression.
  
  
  RESULTS
  Among 69 patients with an indication for antiviral therapy, 41 initiated treatment; 34/41 (83%) completed treatment and 19/41 (46%) achieved SVR. Adequate adherence was observed in 29/41 patients (71%). Two serious adverse events occurred, including one death because of liver failure. Baseline scores for self-assessed health were low, with a significant reduction during treatment. Seventy-one percent of patients (29/41) fulfilled the criteria for clinically significant depression at some time point during treatment. Baseline scores for HRQoL/MADRS-S were associated with treatment completion, SVR, and depression during treatment.
  
  
  CONCLUSIONS
  Despite the low HRQoL and the high occurrence of depression, HCV treatment was feasible and showed satisfactory rates of completion in this cohort of unselected OST recipients.
authors.affiliation: aDepartment of Clinical Sciences, Section for Infectious Diseases, Lund University bAddiction Center cDepartment of Clinical Microbiology, Skane University Hospital, Malmö dDepartment of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg eAddiction Center, Sahlgrenska University Hospital, Gothenburg fDepartment of Infectious Diseases, Karolinska University Hospital, Stockholm gStockholm Center for Dependency Disorders, Stockholm, Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Jerkeman
authors.forename: Gunnar
authors.initials: G
authors.lastname: Norkrans
authors.forename: Christer
authors.initials: C
authors.lastname: Lidman
authors.forename: Johan
authors.initials: J
authors.lastname: Westin
authors.forename: Martin
authors.initials: M
authors.lastname: Lagging
authors.forename: Jan
authors.initials: J
authors.lastname: Frimand
authors.forename: Christian
authors.initials: C
authors.lastname: Simonsberg
authors.forename: Johan
authors.initials: J
authors.lastname: Kakko
authors.forename: Anders
authors.initials: A
authors.lastname: Widell
authors.forename: Per
authors.initials: P
authors.lastname: Björkman
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology; D055030:Drug Users / Q000523:psychology*; D005240:Feasibility Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D019698:Hepatitis C, Chronic / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D006801:Humans; D015994:Incidence; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D058850:Opiate Substitution Treatment; D009293:Opioid-Related Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D011446:Prospective Studies; D011788:Quality of Life; D015819:Substance Abuse, Intravenous / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D011795:Surveys and Questionnaires; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents