May 20-23, 2001
Treating Hepatitis C in Recovering Injection Drug Users on Methadone
Despite the high prevalence of HCV in recovering injection drug users, there is little data on the safety, tolerability, and efficacy of combination interferon/ribavirin therapy in this group. This study presented at DDW (May 2001) reports on the experience of treating persons on Methadone Maintenance using an educational support model for the patients. The authors report that the preliminary viral response rates to therapy, and the discontinuation and side effects profiles were comparable to that seen normally. The authors (Diana Sylvestre, abstract 2886) credit their weekly education/support group with maximizing compliance.
The authors of this abstract used a group support technique that emphasizes peer support and support, education, and maximizes medical resource utilization. They use weekly groups consistingof 15-30 individuals in varying stages of HCV treatment including early diagnosis to post treatment remission or relapse. The sessions combined interactive education about HCV & treatment, peer directed support and discussions, and medical intervention. The groups are geared to recovering substance abusers.
Regardless of the particular design or approach, the group process is a model that can work to support adherence & treatment in HIV and HCV. Abstracts reported at the Retrovirus Conference underscored the need to continue group for a long term as short term groups may not accomplish the long term goals of succeeding with therapy.
Entry criteria for these groups include active HCV infection as demonstrated by positive PCR, liver fibrosis as demonstrated by either liver biopsy or surrogate markers of fibrosis, and stable abstinence from illicit drug use.
29% have cirrhosis. 54% have a psichiatric diagnosis. 12% use alcohol. 74% are Caucasian, 16% African-American, and 10% are Latino. 61% are male. And the average is 50 yrs. Genotype 1: 60% of Caucasians, 80% of African-Americans and 58% of Latinos.
Retrospective analysis of the first 61 patients out the 160 planned patient enrollment shows a side-effect profile (flu 64%, psychiatric 36%, GI 32%) and dose reduction (20%) equivalent to that of historical controls. The overall dropout rate is 18% (2% for medical reasons; 8% for psychiatric; 6% for side effects; n=30). The preliminary end-of-treatment response rate to date (n=30) is 55%, and authors state this is similar to published studies. But, of course this is preliminary to judge the outcomes as we only have ETR data on 30 of 160 planned patients.
However, the authors conclude HCV treatment in recovering injection drug users on methadone is safe, tolerable, and efficacious. They report group treatment can maximize the use of medical resources. Studies are needed in treating active injection drug users, particularly those using harm reduction including needle exchange programs.