We examined the feasibility of hepatitis C treatment in patients on opioid maintenance. One hundred patients with chronic hepatitis C, 50 on methadone maintenance, and 50 with no intravenous drug use or opioid maintenance for at least 5 years were prospectively matched for sex, age, hepatitis C virus (HCV) genotype and HCV RNA. The primary end point was undetectable HCV RNA at 24 weeks posttreatment. Treatment with peginterferon alfa-2b (1.5 g/kg per week) and ribavirin (1000-1200 mg /day) was initiated for 24 weeks (HCV genotype 2, 3) or 48 weeks (HCV genotype 1, 4). Within the first 8 weeks of therapy, discontinuation due to noncompliance or patient request was observed in 22% (11/50) in the methadone group versus 4% (2/50) in the control group (P ‫؍‬ .02). After 8 weeks, there was no significant difference in discontinuation due to noncompliance or patient request I ntravenous drug use is currently the main transmission route of hepatitis C virus (HCV) infection in the Western world. [1][2][3][4][5] The prevalence in intravenous drug users varies between 35% and 95%. 6 Thus, intravenous drug users with HCV represent a relevant public health problem. Combination therapy with pegylated interferon ␣ and ribavirin induces sustained viral responses in treatment-naive patients of 35% to 85%, depending on HCV genotype and HCV viral load. 7,8 Due to these success rates and the convenience of a once weekly injection of pegylated interferons, the acceptance of interferon based therapies has grown with physicians and patients, despite significant treatment-related adverse events. However, individuals with active substance abuse are generally not considered eligible for interferon-based therapy because of poor compliance and the priority of treating the addiction first. Yet some physicians treat patients on opioid maintenance therapy with interferon-based therapies despite the unavailability of clinical trial data to support this practice. Consequently, the present study examines, in a prospective controlled setting, the efficacy and tolerability of pegylated interferon ␣ plus ribavirin in patients with or without methadone maintenance. Patients and MethodsBecause a randomized trial in a setting comparing patients on opioid maintenance with patients not on opioid maintenance as controls is not feasible, we chose a prospectively matched population study design. To be included in the methadone maintenance group, patients had to have been on stable methadone maintenance without the concomitant use of illicit drugs for 6 months. To be enrolled in the control group, patients had to have no history of intravenous drug use, illicit drug use, or opioid

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A cross-sectional study was conducted to compare patients treated with tenofovir with patients never treated with tenofovir. Patients on tenofovir showed a lower mean glomerular filtration rate estimated by creatinine clearance or cystatin C clearance compared with control patients. In total, 24 patients on tenofovir versus five control patients had proteinuria greater than 130 mg/day. In the majority of patients on tenofovir proteinuria was of tubular origin.

In this cohort of HBV/HIV-coinfected individuals, full HBV DNA suppression was achieved in the majority of patients independent of treatment allocation. Loss of HBe- and HBs-antigen was not different between the two study arms. Over a median treatment period of 116 weeks tenofovir was as effective as tenofovir plus lamivudine. Longer treatment periods may be needed to evaluate potential benefits of first-line combination therapy for chronic hepatitis B.