Hepatitis C Treatment of Opioid Dependants Receiving Maintenance Treatment: Results of a Norwegian Pilot Study

Abstract

Background: Many physicians are still skeptic to treat opioid dependants, with or without maintenance treatment, for hepatitis C (HCV) because of concerns about psychiatric comorbidity, stability and adherence. In Norway, there are about 3,500 patients participating in the restrictive medication-assisted rehabilitation (LAR) programs in which all patients are given methadone or buprenorphine maintenance therapy. This study was undertaken to determine whether HCV combination therapy with pegylated interferon α-2a plus ribavirin is feasible, efficient and safe in this patient group. Method: Seventeen patients with HCV genotype 3a were treated for 24 weeks. To optimize compliance, the treatment was given from a department of infectious diseases in cooperation with an LAR center. All injections were given in the LAR center and the patients were given psychosocial support. Results: The compliance was 100%. All responded to the therapy and 16 (94%) were sustained responders. Discussion/Conclusion: This study indicates that compliance and treatment outcome of opioid dependants on methadone or buprenorphine maintenance after 24 weeks of HCV treatment corresponds to that for non-dependants if extra support is given. The treatment should be undertaken in collaboration with specialists in addiction medicine, hepatology and infectious diseases.

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.…”

Chronic hepatitis C in Swedish subjects receiving opiate substitution therapy—Factors associated with advanced fibrosis

“…Despite enrolment in OST programs, only a minority of patients had previously been assessed for HCV, a phenomenon that has been described from other countries (23,24). Subjects without anti-HCV antibodies were characterized by a shorter duration between their first illicit drug injection and OST initiation, suggesting that early enrolment for OST could contribute to the reduction of HCV infection among injecting heroin users (25).…”

Korttids hepatitt C-behandling av heroinavhengige pasienter

“…Lavt antall og seleksjon betyr at funnene må tolkes med varsomhet. Likevel viser resultatene fra denne pilotstudien samsvar med andre studier (16,17) og indikerer at det ikke lenger er grunn til å ekskludere LAR-pasienter fra tilbud om livsviktig kombinert HCV-behandling. I tillegg viste studien at korttidsbehandling over 14 uker for LAR-pasienter med hepatitt C genotype 3 kan gi et tilnaermet like bra resultat i forhold til etterlevelse, retensjon i behandling og varig virusrespons som tradisjonell behandling over 24 uker.…”

“…I tillegg viste studien at korttidsbehandling over 14 uker for LAR-pasienter med hepatitt C genotype 3 kan gi et tilnaermet like bra resultat i forhold til etterlevelse, retensjon i behandling og varig virusrespons som tradisjonell behandling over 24 uker. Krook og medarbeidere hadde en etterlevelse på 100 % og en varig virusresponsrate på 94 % blant sine LAR-pasienter med et tilsvarende opplegg (17). I studien til Mauss og medarbeidere droppet 22 % ut tidlig i forlø-pet, og man observerte en varig virusrespons på 48 % i metadongruppen (16).…”

“…Vi mente at disse bivirkningene ikke skulle behandles med doseøkning av LAR-medikasjonen, men med informasjon og støtte. Ingen pasienter i vår studie trengte å justere metadon-eller buprenorfindosen, i motsetning til i Krook og medarbeideres studie (17). De trengte heller ikke antidepressiver.…”