Concurrent Addiction and HCV Treatment Improves HCV Treatment Completion

The majority of hepatitis C virus (HCV) cases in the United States occur in people with drug use. However, HCV treatment initiation and completion rates are low among patients with drug use who are referred to specialty clinics potentially due to mutual distrust encountered in traditional medical settings on the part of the patient and the physician. The purpose of this meta-analysis was to determine the impact of support services on HCV treatment completion and success rates among HCV-infected people with drug use, measured by sustained virologic response (SVR), which is defined as undetectable viral load at the end of treatment and 24 weeks subsequent. Studies were eligible for the meta-analysis if they included at least 10 patients with HCV and drug use treated with pegylated interferon and ribavirin, and reported a treatment outcome. The meta-analysis included 36 studies—published between 2004 and 2011—that collectively reported data from 2866 patients.

• The HCV treatment completion rate was 83.4% (95% confidence interval [CI]: 77.1–88.9%).
• Among 25 studies including patients undergoing concurrent addiction treatment, the higher the proportion of addiction-treated patients, the greater the likelihood of treatment completion.
• After removing outliers, the pooled SVR rate was 55.5% (95% CI: 50.6–60.3%). Genotype 1 and 4 infection and HIV coinfection were associated with a decreased SVR rate; after adjusting for these factors, SVR was associated with treatment performed by a multidisciplinary team.

Comments:

Despite some heterogeneity of studies, the results of this meta-analysis suggest that overall treatment completion SVR rates among HCV-infected drug users undergoing treatment with pegylated interferon and ribavirin are comparable to previous trials that excluded people with drug use, particularly when patients are concurrently treated for addiction.

Jeanette M. Tetrault, MD

Reference:

Dimova RB, Zeremski M, Jacobson IM, et al. Determinants of hepatitis C virus treatment completion and efficacy in drug users assessed by meta-analysis. Clin Infect Dis. 2013;56(6):806–816.