Management of hepatitis C in active drugs users: experience of an addiction care hepatology unit

Comment on the updated AASLD practice guidelines for the diagnosis, management, and treatment of hepatitis C: Treating active drug users #

“…In making our recommendation, we placed greater emphasis on treatment efficacy as determined in a large international, multicenter trial 7 than on data from smaller trials or on considerations of cost. 5,6 We agree that some patients with HCV genotype 2 and 3 may prefer to receive the 12-week to 14-week treatment regimen or there may be specific instances in which 12-14 weeks of treatment might be justifiable. For example, treatment might be appropriately abbreviated in a nonobese person who achieved a rapid virologic response and has significant adverse events.…”

“…Dalgard and Mangia disagree with our recommendation that all patients with genotype 2 or 3 HCV infection should be treated for 24 weeks, suggesting that, even though there is a higher relapse rate with a 12-week to 14-week treatment course, this could be compensated for by careful patient selection, and that furthermore, this would result in improved cost-effectiveness of the treatment. They point to two of their own publications to support these views, 5,6 one of which had not yet been published when the literature search of these guidelines was completed. 6 While acknowledging the additional relevant data of these publications, we believe that our recommendation for treatment for 24 weeks remains appropriate for most patients with genotype 2 or 3 HCV infection.…”

“…They point to two of their own publications to support these views, 5,6 one of which had not yet been published when the literature search of these guidelines was completed. 6 While acknowledging the additional relevant data of these publications, we believe that our recommendation for treatment for 24 weeks remains appropriate for most patients with genotype 2 or 3 HCV infection. In making our recommendation, we placed greater emphasis on treatment efficacy as determined in a large international, multicenter trial 7 than on data from smaller trials or on considerations of cost.…”

“…3 The literature offers several examples of successful models for delivering HCV care and treatment to active drug users. [4][5][6][7][8][9][10][11] We hope that this contradiction is resolved so that the Practice Guidelines are internally consistent in suggesting that clinicians broadly consider HCV treatment for active drug users in the context of supportive, multidisciplinary care.…”

Hepatitis C management by addiction medicine physicians: Results from a national survey

“…Although past treatment options have been relatively ineffective, new treatment advances have substantially improved outcomes (Fried et al, 2002;Manns et al, 2001). A growing number of studies now provide evidence for the efficacy of interferon-based therapy for HCV-infected patients with active substance abuse disorders (Backmund, Meyer, Von Zielonka, & Eichenlaub, 2001;Cournot et al, 2004;Dalgard et al, 2002;Sylvestre, Litwin, Clements, & Gourevitch, 2005;Van Thiel, Anantharaju, & Creech, 2003). However, despite the high prevalence of HCV infection among IDUs, few have been treated with interferon-based antiviral therapy Hagan et al, 2006).…”