Adherence to Hepatitis C Treatment among Recovering Heroin Users on Methadone Ma

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Adherence to Hepatitis C Treatment among Recovering Heroin Users on

Methadone Maintenance

By Liz Highleyman

Because hepatitis C virus (HCV) is easily transmitted via

contaminated needles and other drug injection equipment, a large

proportion of injection drug users (IDUs) have chronic hepatitis C.

However, IDUs are often denied treatment for hepatitis C due to

concerns about adherence. This is the case despite limited and

conflicting data about the impact on adherence of issues such as

psychiatric conditions and concurrent illegal drug use. HCV treatment

guidelines state that IDUs should not be excluded from treatment as a

group, but that each individual should be evaluated for treatment on

a case-by-case basis.

Some past studies have produced good sustained response rates for

IDUs treated with interferon-based therapy, but results from clinical

trials do not always carry over into " real world " settings.

As reported in the September 2007 issue of the European Journal of

Gastroenterology and Hepatology, Sylvestre, MD, from the

University of California at San Francisco and colleagues evaluated

the impact of mental health issues, active drug use, and other

potential adherence barriers in a real-world sample of recovering

drug users on methadone maintenance therapy.

The prospective observational study included 71 patients on methadone

maintenance who received interferon plus ribavirin combination

therapy in a community-based clinic staffed by providers with

expertise in treating addiction disorders. Adherence was assessed

using monthly interviews, medication counts, and urine toxicology

testing.

Results

· Overall, 48 patients (68%) were adherent to anti-HCV

therapy.

· Adherent patients were significantly more likely than non-

adherent patients to achieve a sustained virological response (42% vs

4%, respectively).

· Patients with and without a prior psychiatric history had

similar rates of adherence (64% vs 72%, respectively; P > 0.5).

· Initiation of new psychiatric medications during HCV

treatment was associated with improved adherence overall (P = 0.02)

and in patients that did not have a pre-existing psychiatric

diagnosis (P = 0.04).

· There was a trend towards reduced adherence in patients

without a period of drug abstinence before starting HCV treatment

compared with those who had been abstinent for at least 1 month (46%

vs 72%; P = 0.10).

· Although occasional drug users were similarly adherent

compared with those who were completely abstinent, patients who

relapsed to regular drug use showed a significantly lower level of

adherence (P = 0.03).

Conclusion

" We conclude that the majority of methadone-maintained drug users can

adhere to HCV treatment, even those with psychiatric illness and

relatively limited pretreatment drug abstinence, " the study authors

wrote.

" Lack of pre-HCV treatment drug abstinence and regular drug use

during HCV treatment may be relative barriers to medication

adherence, but the initiation of psychiatric medications during HCV

treatment may be a helpful intervention, " they added.

They concluded that, " This report provides further evidence for an

individualized approach to HCV treatment that does not categorically

exclude patients with potential barriers such as mental illness and

limited drug abstinence. "

10/23/07