Active intravenous drug use during chronic hepatitis C therapy does not reduce sustained virological response rates in adherent patients

Abstract

Reluctance has been expressed about treating chronic hepatitis C in active intravenous (IV) drug users (IDUs), and this is found in both international guidelines and routine clinical practice. However, the medical literature provides no evidence for an unequivocal treatment deferral of this risk group. We retrospectively analyzed the direct effect of IV drug use on treatment outcome in 500 chronic hepatitis C patients enrolled in the Swiss Hepatitis C Cohort Study. Patients were eligible for the study if they had their serum hepatitis C virus (HCV) RNA tested 6 months after the end of treatment and at least one visit during the antiviral therapy, documenting the drug use status. Five hundred patients fulfilled the inclusion criteria (199 were IDU and 301 controls). A minimum exposure to 80% of the scheduled cumulative dose of antivirals was reached in 66.0% of IDU and 60.5% of controls (P = NS). The overall sustained virological response (SVR) rate was 63.6%. Active IDU reached a SVR of 69.3%, statistically not significantly different from controls (59.8%). A multivariate analysis for treatment success showed no significant negative influence of active IV drug use. In conclusion, our study shows no relevant direct influence of IV drugs on the efficacy of anti-HCV therapy among adherent patients.

Should active injecting drug users receive treatment for chronic hepatitis C?

“…A previous study, carried out retrospectively in 500 patients, has also demonstrated that neither active intravenous drug using, nor substitution therapy reduces SVR rates in adherent CHC patients (4) . However, data concerning initial behavior regarding informed consent and enrollment to therapy, in relation with active drug using, was not reported.…”

“…Current European guidelines, with the exception of France, contain restrictive recommendations for therapy in patients actively injecting drugs (10) . Furthermore, these patients are usually excluded from clinical studies as they are believed to manifest high-risk behavior (2,4,9) . Thus, the therapeutic algorithm of CHC still remains controversial in this group of patients.…”

Determinants of successful chronic hepatitis C case finding among patients receiving opioid maintenance treatment in a primary care setting

“…In addition OMT has been shown to be an effective framework for adherence and virological success in HIV treatment 4 5 and preventing tuberculosis in patients with HIV 6 . There is increasing evidence of a similar therapeutic response to CHC treatment in patients on OMT, including patients with active IDU, compared to patients without drug dependence [7][8][9][10] . In light of the latest treatment evidence, effective CHC case finding becomes an important prerequisite to provide HCV care to this high risk population with the potential to prevent a significant number of patients from ESLD.…”

Exosome-mediated transmission of hepatitis C virus between human hepatoma Huh7.5 cells

“…Indeed, HCV is known to evade humoral immune responses, as indicated by a lack of resistance to HCV reinfection in i.v. drug users (13), HCV reinfection during liver transplantation (14), and an ongoing difficulty of developing effective vaccines. The role of exosomes in HCV infection is still largely unknown.…”