Treatment of Hepatitis C within a Methadone Maintenance Program Yields Results Comparable to Treatment via Other Models of Care

Hepatitis C virus (HCV) affects more than 4 million people in the US, 60% of whom have a history of injection drug use (IDU). Concerns over treatment adherence, psychiatric comorbidity, ongoing drug use, and optimal timing of HCV treatment initiation have resulted in unwillingness on the part of many physicians to treat HCV in patients with IDU. This retrospective study investigated outcomes in patients with co-occurring HCV infection and opioid dependence (N=73) treated for HCV within an ongoing methadone maintenance program. At treatment initiation, 49% of patients had continuing drug use, 67% had psychiatric comorbidity, and 32% had HIV coinfection. Sixty-eight percent of patients had genotype 1 or 4 virus, 16% had genotype 2 virus, and 15% had genotype 3 virus. Treatment for HCV was delivered by internists via standardized protocol with pegylated interferon alpha-2a or alpha-2b and ribavirin. Main outcome variables were undetectable viral load at the end of treatment and at 6 months following treatment completion.

• Eighty-six percent of patients completed at least 12 weeks of HCV treatment.

• Fifty-five percent of patients had an undetectable viral load at the end of treatment, and 45% had an undetectable viral load 6 months post-treatment (sustained viral response [SVR]).

• Forty percent of patients with genotype 1 or 4 virus, 75% of patients with genotype 2 virus, and 36% of patients with genotype 3 virus achieved SVR.

• Thirty percent of patients continued to use illicit substances during treatment, and 23% received a methadone dose increase.

Comments:

Patients receiving methadone for opioid dependence can be successfully treated for HCV in a colocated methadone maintenance and primary medical care program. Although the study design did not allow for comparison with separate, off-site HCV care, it is possible that co-location with methadone maintenance increased HCV treatment adherence and facilitated delivery of interferon injections. Additionally, internists treating patients within the structure of an addiction treatment program may be more comfortable with patients’ continued substance abuse and be better able to address co-occurring psychiatric disease and HIV infection.

Jeanette M. Tetrault, MD

Reference:

Litwin AH, Harris KA Jr, Nahvi S, et al. Successful treatment of chronic hepatitis C with pegylated interferon in combination with ribavirin in a methadone maintenance treatment program. J Subst Abuse Treat. 2009;37(1):32–40.