Coordinated Treatment for Hepatitis C in Injection Drug Users

Since 2002, consensus guidelines have recommended coordinated care for treating chronic hepatitis C (HCV) among injection drug users (IDUs). This small, uncontrolled study evaluated one such model of care implemented by multidisciplinary teams across 6 infectious disease clinics and 11 drug treatment units in Italy.

IDUs in drug treatment who were anti-HCV positive were screened for chronic HCV, counseled about the disease, and referred to an infectious disease clinic for further evaluation. When indicated, patients received treatment (weekly injections of pegylated interferon and oral ribavirin twice per day) and were monitored on the drug treatment unit.

• Over approximately 1 year, 169 patients were referred to the clinics, but 69% were ineligible to receive treatment (e.g., 54 for normal ALT values, 14 for alcohol abuse). “Uncontrolled” psychiatric conditions were among the exclusions, but none were reported.
• Fifty-five percent of patients who received treatment had a sustained virological response (SVR): 35% of patients with genotypes 1 or 4 (the most common genotypes in IDUs in the United States) and 70% of patients with genotype 3.
• Treatment was discontinued in 19 (36%) patients for various reasons (e.g., side effects, relapse).

Comments:

Effective models of coordinated care are greatly needed for IDUs given their high prevalence of both HCV and contraindications to treatment. This study’s small and selective sample, the uncertain fate of patients with comorbid psychiatric conditions, and the impressive SVRs suggest the need for better controlled studies. Nonetheless, this report implies that coordinated hepatitis C and addiction treatment might be feasible in settings with universal health coverage.

Peter D. Friedmann, MD, MPH

Reference:

Guadagnino V, Trotta MP, Montesano F, et al. Effectiveness of a multi-disciplinary standardized management model in the treatment of chronic hepatitis C in drug addicts engaged in detoxification programmes. Addiction. 2007;102(3):423–431