title: HCV antiviral therapy in injection drug users: difficult to treat or easy to cure?
abstract: Background and rationale of the study. Hepatitis C infection is very common among injection drug users(IDUs). In clinical practice there is reluctance to treat IDUs, because considered difficult-to-treat. Aim of this study was to evaluate the response to antiviral treatment in IDUs compared to non-IDUs.
  
  
  RESULTS
  In this observational retrospective study, 204 non cirrhotic patients(112 IDUs, 92 non-IDUs) with chronic hepatitis C, treated with PEG-IFN and ribavirin in a tertiary centre for IDUs of Southern Italy from 2008 to 2011 were analyzed. Age, sex, genotype, steatosis, response to previous therapy, rapid(RVR), early(EVR), end-of-treatment(ETR), sustained(SVR) virological response were evaluated. IDUs were mainly young and males, with prevalence of genotype 3. A higher SVR rate in IDUs group compared to non-IDUs only in PerProtocol(PP) analysis (90% vs. 78,9% ;p = 0.04). On the contrary, in IntentionToTreat(ITT) analysis, no significant difference was relieved. A higher SVR rate at ITT analyses in naïve non-IDUs patients was found (76,13% vs. 90%, p = 0.021), but at PP analysis wasn't confirmed. Treatment was well tolerated; a higher dropout rate was reported in IDUs (24 patients) compared to non-IDUs (2 patients). In order to exclude the effect of viral genotypes on SVR a genotype matched statistical analysis was done and no difference was found.
  
  
  CONCLUSIONS
  IDUs naïve patients, due to young age and high prevalence of genotype 3, appear good candidates to dual antiviral therapy with high SVR rates. Dropout is the main non-response cause among these subjects, but through an optimal monitoring program with a multidisciplinary setting, their "difficult to treat" characteristics can be overcome.
authors: Internal Medicine and Hepatology Unit University of Salerno. Baronissi, Italy.
authors: Marcello
authors: M
authors: Persico
authors: Department of Mental Health, Section of Infectious Disease, Second University of Naples. Naples, Italy.
authors: Nicola
authors: N
authors: Coppola
authors: Internal Medicine and Hepatology Department, Second University of Naples. Naples, Italy.
authors: Valerio
authors: V
authors: Rosato
authors: Department of Health Sciences, University Magna Graecia. Catanzaro, Italy.
authors: Ludovico
authors: L
authors: Abenavoli
authors: Internal Medicine and Hepatology Unit, University of Salerno. Baronissi, Italy.
authors: Mario
authors: M
authors: Masarone
authors: UOC Dipendenza ASL-SA/DS65. Battipaglia, Italy.
authors: Antonio
authors: A
authors: De Luna
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D004337:Drug Carriers; D004359:Drug Therapy, Combination; D055030:Drug Users; D005260:Female; D005500:Follow-Up Studies; D019698:Hepatitis C, Chronic / Q000188:drug therapy*; D006801:Humans; D016898:Interferon-alpha / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000627:therapeutic use*; D011994:Recombinant Proteins / Q000627:therapeutic use; D012189:Retrospective Studies; D012254:Ribavirin / Q000627:therapeutic use*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D004337:Drug Carriers; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C100416:peginterferon alfa-2a