Effectiveness of chronic hepatitis C treatment in drug users in routine clinical practice: results of a prospective cohort study.

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Eur J Gastroenterol Hepatol. 2010 Mar 25. [Epub ahead of print]

Effectiveness of chronic hepatitis C treatment in drug users in routine clinical

practice: results of a prospective cohort study.

Melin P, Chousterman M, Fontanges T, Ouzan D, Rotily M, Lang JP, Marcellin P,

Cacoub P; for the CheObs Study Group.

aDepartment of Polyvalent Medicine, Hospital of Saint Dizier, Saint-Dizier

bCentre de soins, d'accompagnement et de prévention en addictologie 52

cDepartment of Hepato-Gastroenterology, Hospital of Créteil (CHIC), Créteil

dDepartment of Hepato-Gastroenterology, General Hospital of Bourgoin, Bourgoin

Jailleu eDepartment of Hepato-Gastroentrology, Arnault Tzanck Institute, Saint

t du Var fClinSearch, Bagneux gDepartment of Psychiatry and Addiction,

Hospital of Erstein, Erstein hDepartment of Hepatology, Beaujon Hospital, Pôle

des Maladies de l'Appareil Digestif iINSERM U 773, CRB3, University of Paris

VII, Beaujon Hospital, Clichy jDepartment of Internal Medicine,

Pitié-Salpêtrière Hospital kPierre and Marie Curie (Paris 6) University, CNRS

UMR 7087, Paris, France.

Abstract

OBJECTIVE: Injection drug users are often excluded from hepatitis C virus (HCV)

treatment. This study compares sustained virological response, adherence, and

quality of life in patients with or without a history of illicit drug use in

routine clinical practice. METHODS: This is a post-hoc analysis of a

prospective, observational study conducted in 1860 patients who received

peginterferon alpha-2b/ribavirin combination therapy. Nondrug users (NDUs) were

defined as patients without a history of drug addiction; former drug users

(FDUs) as patients who had stopped using illicit drugs or opioid maintenance

therapy and active drug users (ADUs) as patients using illicit drugs or on

opioid maintenance therapy. Virological response, adherence, and the

health-related quality of life were assessed by the measure of HCV RNA in the

serum, self-report and 36-item short-form health survey Questionnaire,

respectively. RESULTS: The analyzed population included 1038 (56%) NDUs, 578

(31%) FDUs, and 244 (13%) ADUs. About 85% of ADUs were on opioid maintenance

therapy and 25% used illicit drugs. Although ADUs had a more chaotic lifestyle

and more psychiatric disorders, sustained virological response of ADUs (58%) did

not differ from that of NDUs (49%) and FDUs (51%) (P=0.133). Adherence rates

were 39% in NDUs and FDUs, and 37% in ADUs (P=0.883). Health-related quality of

life was improved in the three groups after the end of treatment. CONCLUSION:

Our study suggests that HCV therapy in ADUs on opioid maintenance therapy is as

effective as in other HCV patients. The effectiveness of HCV therapy in illicit

drug users needs to be evaluated in further studies.

PMID: 20351554 [PubMed - as supplied by publisher]