Hepatitis C Treatment among Recovering Heroin Users on Methadone Maintenance
Because hepatitis C virus (HCV) is
easily transmitted via contaminated needles and other drug injection equipment,
a large proportion of injection
drug users (IDUs) have chronic hepatitis C.
However, IDUs are often denied treatment for
hepatitis C due to concerns about adherence. This is the case despite
limited and conflicting data about the impact on adherence of issues such as
psychiatric conditions and concurrent illegal drug use. HCV treatment
guidelines state that IDUs should not be excluded from treatment
as a group, but that each individual should be evaluated for treatment on a
Some past studies have produced good
sustained response rates for IDUs treated with interferon-based
therapy, but results from clinical trials do not always carry over into
“real world” settings.
As reported in the September 2007
issue of the European Journal of Gastroenterology and Hepatology, Diana
Sylvestre, MD, from the University of California at San Francisco and colleagues
evaluated the impact of mental health issues, active drug use, and other
potential adherence barriers in a real-world sample of recovering drug users on
methadone maintenance therapy.
The prospective observational study
included 71 patients on methadone maintenance who received interferon plus
ribavirin combination therapy in a
community-based clinic staffed by
providers with expertise in treating addiction disorders. Adherence was assessed
using monthly interviews, medication counts, and urine toxicology testing.
48 patients (68%) were adherent to anti-HCV
patients were significantly more likely than non-adherent patients to achieve a
sustained virological response (42% vs 4%,
with and without a prior psychiatric history had similar rates of adherence (64%
vs 72%, respectively; P > 0.5).
Initiation of new psychiatric
medications during HCV treatment was associated with improved adherence overall
(P = 0.02) and in patients that did not have a pre-existing psychiatric
diagnosis (P = 0.04).
a trend towards reduced adherence in patients without a period of drug
abstinence before starting HCV treatment compared with those who had been abstinent for at
least 1 month (46% vs 72%; P = 0.10).
occasional drug users were similarly adherent compared with those who were completely abstinent, patients who relapsed to
regular drug use showed a significantly lower level of adherence (P = 0.03).
“We conclude that the majority of
methadone-maintained drug users can adhere to HCV treatment, even those with
psychiatric illness and relatively limited pretreatment drug abstinence,” the
study authors wrote.
“Lack of pre-HCV treatment drug
abstinence and regular drug use during HCV treatment may be relative barriers to
medication adherence, but the initiation of psychiatric medications during HCV
treatment may be a helpful intervention,” they added.
They concluded that, “This report
provides further evidence for an individualized approach to HCV treatment that
does not categorically exclude patients with potential barriers such as mental
illness and limited drug abstinence.”
Sylvestre and BJ Clements. Adherence to hepatitis C
treatment in recovering heroin users maintained on methadone. European
Journal of Gastroenterology and Hepatology 19(9): 741-747. September