Response To Treatment of Hepatitis C in Individuals With A Recent History of Intravenous Drug Abuse

Thiel, David H. Van; Anantharaju, Abhinandana; Creech, Steven

doi:10.1111/j.1572-0241.2003.07702.x

Cited by 48 publications

(21 citation statements)

References 16 publications

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“…Although some authors have identified increased depression score at baseline as a risk factor for higher depression score during treatment with standard IFN-␣, our data are in line with the results of other controlled trials that did not find differences in changes in depression scores during IFN-␣ treatment between patients with preexisting depression and nonpsychiatric controls. 17,[27][28][29][30][31] One possible explanation for the higher increase in depression scores in the control group might be the smaller number of patients who received antidepressants before antiviral therapy was started. In fact, recent data showed that at least for preexisting depressive symptoms, preemptive treatment with citalopram can decrease the incidence of major depressive episodes during treatment of chronic hepatitis C with pegIFN-␣-2b and ribavirin.…”

Section: Discussionmentioning

confidence: 99%

Hepatitis C treatment in “difficult-to-treat” psychiatric patients with pegylated interferon-alpha and ribavirin

et al. 2007

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We investigated and compared the results of treating the chronic hepatitis C (HCV) infection of different groups of psychiatric-risk patients and controls with pegylated interferon alpha (pegIFN-␣) plus ribavirin. Seventy patients were prospectively screened for psychiatric disorders. Seventeen patients without psychiatric diseases or drug addiction (controls), 22 patients with psychiatric disorders, 18 patients who had received methadone substitution treatment and 13 patients who were former drug users were treated with pegIFN-␣ plus ribavirin. Sustained virological response (SVR), adherence, and psychiatric side effects (using the MontgomeryAsberg Depression Rating Scale and the Brief Psychiatric Rating Scale) in the groups were compared. An SVR was found in 58.6% of all patients: 58.8% of the controls, 50% of psychiatric patients, 72.2% of methadone patients, and 53.8% of former drug users. Methadone-substituted patients and former drug users had significantly higher dropout rates. Scores for neither depressive nor psychotic symptoms differed significantly between groups during treatment. However, the controls had lower pretreatment scores, followed by a significant higher increase to maximum scores. A stepwise logistic regression model showed that only genotype, not group (control, psychiatric, methadone, or former drug abuse), type of psychiatric diagnosis (affective disorder, personality disorder, or schizophrenic disorder), depression scores before and during treatment, change in depression score, antidepressive treatment, sex, or liver enzymes before treatment, was associated with SVR. Conclusion: In an interdisciplinary treatment setting psychiatric diseases and/or drug addiction did not negatively influence psychiatric tolerability of and antiviral response rate to HCV treatment with pegIFN-␣ and ribavirin. ( I t is estimated that 170 million people worldwide are infected with the hepatitis C virus (HCV). Although the prevalence in the general population ranges between 1% and 2.4%, 1,2 the prevalence of HCV infection in patients with a chronic psychiatric disorder has been found to be significantly higher-between 6.8% and 8.5%. 3,4 Moreover, between 60% and 98% of intravenous drug users are chronically infected with HCV. [5][6][7] Interferon alpha (IFN-␣) is still the only effective treatment for chronic hepatitis C infection. In 1998, 2 studies showed that a combined regimen of IFN-␣ with ribavirin increased the sustained virological response (SVR) from 10% to 40%. 8,9 The development of pegylated interferons (pegIFN alpha-2a and pegIFN alpha-2b), characterized by a significantly longer half-life that allowed subcutaneous injection only once a week, further significantly improved therapeutic outcome when used in treatment in combination with ribavirin. 10-12 SVR rates between 51% and 82% have been reported, depending on the virus genotype. 10,11 Antiviral treatment of chronic hepatitis C with IFN-␣ is associated with several neuropsychiatric side effects such as fatigue, anhedonia, depression, irritab...

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Section: Discussionmentioning

confidence: 99%

Hepatitis C treatment in “difficult-to-treat” psychiatric patients with pegylated interferon-alpha and ribavirin

et al. 2007

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“…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).…”

Section: Introductionmentioning

confidence: 99%

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

Litwin

Kunins

Berg

et al. 2007

Journal of Substance Abuse Treatment

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Drug users are disproportionately affected by hepatitis C virus (HCV), yet they face barriers to health care that place them at risk for levels of HCV-related care that are lower than those of nondrug users. Substance abuse treatment physicians may treat more HCV-infected persons than other generalist physicians, yet little is known about how such physicians facilitate HCV-related care. We conducted a nationwide survey of American Society of Addiction Medicine physicians (n = 320) to determine substance abuse physicians' HCV-related management practices and to describe factors associated with these practices. We found that substance abuse treatment physicians promote several elements of HCV-related care, including screening for HCV antibodies, recommending vaccinations against hepatitis A and B, and referring patients to subspecialists for HCV treatment. Substance abuse physicians who also provide primary medical or HIV-related care were most likely to facilitate HCVrelated care. A significant minority of physicians were either providing HCV antiviral treatment or willing to provide HCV antiviral treatment.

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“…Indeed, injection drug users respond to HCV treatment in a fashion similar to those without a history of substance abuse. 14,15 Interim data from a recent study suggest that treatment of HCVinfected individuals utilizing methadone maintenance for the control of opioid addiction is as effective as treatment for non-drug users with HCV infection, although general management issues are more difficult to handle. 16 Currently, treatment recommendations for individuals on methadone maintenance therapy, endorsed by the American Association for the Study of Liver Disease and the Infectious Diseases Society of America, 17 state that the use of methadone does not preclude medical management of hepatitis C. However, it must be noted that patients on methadone maintenance therapy may have difficulty in completing interferon-based therapy regimens.…”

Section: Hcv Care and Treatment And Injection Drug Usementioning

confidence: 99%

Hepatitis C infection and injection drug use: The role of hepatologists in evolving treatment efforts

2004

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Response To Treatment of Hepatitis C in Individuals With A Recent History of Intravenous Drug Abuse

Cited by 48 publications

References 16 publications

Hepatitis C treatment in “difficult-to-treat” psychiatric patients with pegylated interferon-alpha and ribavirin

Hepatitis C treatment in “difficult-to-treat” psychiatric patients with pegylated interferon-alpha and ribavirin

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

Hepatitis C infection and injection drug use: The role of hepatologists in evolving treatment efforts

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