Intravenous Drug Users Can Achieve a High Sustained Virological Response Rate: experience From Croatian Reference Center for Viral Hepatitis

Abstract

BackgroundHepatitis C virus (HCV) is one of the major infectious disease agents among injecting drug users (IVDUs). However, most of the IVDUs are not still treated.ObjectivesTo examine the treatment course, adherence, tolerability and safety profiles and SVR rates in IVDUs compared to non-IVDUs.Patients and MethodsDemographic and clinical data were collected from medical records of 345 adult patients diagnosed with chronic hepatitis C (CHC) who were treated with a PEG-IFN-α and ribavirin in Croatian Reference Center for Viral Hepatitis in Zagreb between January 2003 and January 2010. Efficacy, safety and tolerability treatment profiles were analyzed in IVDUs vs. non-IVDUs. Positive predictors for treatment outcome were evaluated by univariate and multivariate logistic regression.ResultsA total of 106 (30.46%) IVDUs were identified. The IVDUs were mainly male (81.13% vs. 52.30%, P = 0.0001), young (mean ± SD age: 32.46 ± 5.33 y vs. 46.12 ± 11.48 y, P = 0.0001), had lower fibrosis and HAI score (measured by ISHAK) and shorter duration of infection (mean ± SD: 8.98 ± 5.87 vs. 16.79 ± 8.99 y, P = 0.0001) compared to non-IVDU group. In IVDUs, genotype 1a (24.52%) and 3a (38.68%) were predominant. There were no differences in completion rate between the two studied groups. IVDUs achieved a significantly higher rate of overall SVR (70.75% vs. 51.04%, P < 0.0009) and in genotypes 1 and 4 (65.08% vs. 48.73%, P = 0.0294) vs. non-IVDUs. Treatment discontinuation rates due to side-effects were not significantly different in IVDUs and non-IVDUs (2.83% vs. 7.11%, P = 0.1390). IVDU group had a higher rate of lost to follow-up (13.21% vs. 4.60%, P = 0.0071). There were no statistically significant differences in SVR rate between IVDUs with, or without substitution therapy (55.55% vs. 74.62%, P = 0.0866). Independent predictors of SVR were age < 40 years and genotypes 2 and 3. Type of PEG-IFN-α used was not associated with SVR.ConclusionsTreatment of CHC in IVDUs should strongly be encouraged as they have positive predictors for achieving SVR such as younger age, shorter duration of infection, and consequently favorable histological stage of the disease, and good adherence to treatment. There is no difference in safety and tolerability profiles of treatment in IVDUs compared to patients with no history of drug abuse.

Quality of Life Assessment in Antidepressant Treatment of Patients with Depression and/Or Anxiety Disorder

“…Our test group regarding the origin of infection was younger for 17.14 years with statistical significancy (p<0.001). Similar statistical significant difference was noted by the other authors in their studies (p=0.0001; p<0.001; p<0.001) (17, 18, 19). In other sudies the age of IVDU was 21-59 years and male was present by 65.9%-94% (20-25).…”

“…EVR in our IVDU group was higher related to 84% in the same population that was noticed by Fried, but in the same time it was lower than excellent 100% among drug users in the study by Alvarez-Uria et all. ETR in the same population group was higher than ETR noticed in the studies of other authors (68%-90.1%) (20, 21, 26, 30) such as the SVR value in the literature (48.4% - 70.75%) (8, 17, 19, 20, 24, 25, 30-33). SVR among general population in the literature have had some higher value (51.04% - 66.7%) relating to our study (17, 23, 26, 29, 34).…”

Hepatitis C genotype distribution and homology among geographically disparate injecting drug users in Afghanistan

“…Genotype has implications for treatment; in most of these Asian countries, hepatitis C treatment is limited to urban centers or is not available, particularly for disenfranchised groups like injecting drug users. Combination therapy with HCV protease inhibitors and pegylated interferon has demonstrated sustained viral reduction in injecting drug users receiving treatment, particularly among those with type 3a [Robaeys et al, ; Hellard et al, ; Kurelac et al, ]. However, most treatment programs are limited to drug dependent individuals who have achieved abstinence.…”

The success of treatment of chronic hepatitis C in opiate addicts in Clinical center of Vojvodina

“…Although their sample was much smaller (30 patients), the patients were selected for antiviral therapy according to the same principle, and they had very similar demographic and clinical characteristics and were treated by the same therapeutic protocol as ours. Only 30.46% of patients treated with standard viral therapy for CHC were opiate addicts who were included in the study of Kurelac et al from the Croatian Reference Center for Viral Hepatitis [34]. They reported that successful therapeutic response in their study was achieved in only 57.10% of all patients with CHC, and in 70.75% of intravenous drug addicts.…”