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Research Summary

Injection-Drug and Heavy Alcohol Use Did Not Affect Hepatitis-C Treatment Outcomes in an Australian Study

Clinical trials have demonstrated the efficacy of interferon-based therapies for treatment of chronic hepatitis C virus (HCV) infection, but such studies often exclude patients with alcohol- and drug-related problems. This prospective observational cohort study recruited HCV-infected patients from 24 HCV clinics in a variety of settings, including drug-treatment and correctional centers, throughout Australia. Analyses focused on 550 treatment-naïve patients recruited between 2008–2009 who subsequently underwent treatment for HCV with pegylated-interferon and ribavirin. The median age was 46; the majority were male (63%) and had a history of prior injection drug use (68%), though few (5%) had current injection drug use. Thirty-five patients (6.4%) had current heavy alcohol use.* The primary viral genotypes were 1 and 3 (50% and 42%, respectively). The median duration of infection was 19 years (interquartile range, 10–27 years).

  • Among all patients who received at least 1 dose of interferon, sustained viral response (SVR) was achieved in 60% of patients overall (50% for genotype 1 and 70% for genotypes 2 and 3). Ten percent of patients discontinued early due to nonresponse, and 10% discontinued due to adverse events or side effects.
  • In the multivariable analysis, there was no significant association between SVR and past injection drug use (OR=1.67), current injection drug use (OR=0.72), or current heavy alcohol use (OR=1.10).

*Defined as >20 g per day in this study.

Comments:

This study demonstrated the effectiveness of antiviral therapy when delivered in a “real-world” setting, with SVR rates nearly comparable to results observed in clinical trials. It is encouraging that the investigators did not find significant associations between injection-drug and heavy alcohol use and treatment outcomes. However, the study may suffer from selection bias, as patients with more severe drug or alcohol problems are often excluded from treatment in clinical practice. Furthermore, the systems of delivery of HCV care in Australia may be unique, making it difficult to generalize findings. Finally, this study predates the introduction of directly acting antiviral therapies for HCV; additional studies are needed to assess effectiveness of newer treatment regimens. Judith Tsui, MD, MPH

Reference:

Gidding HF, Law MG, Amin J, et al. Hepatitis C treatment outcomes in Australian clinics. Med J Aust. 2012;196(10):633–637.

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