Treatment of hepatitis C infection for current or former substance abusers in a community setting
A. John-Baptiste
Department of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, Canada
University Health Network, Toronto, ON, Canada
Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto, ON, Canada
Search for more papers by this authorM. Varenbut
Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
Ontario Addiction Treatment Centres, Richmond Hill, ON, Canada
Search for more papers by this authorM. Lingley
Round Trip Travel Health Clinic, Markham, ON, Canada
Search for more papers by this authorT. Nedd-Roderique
Department of Physiology, University of Toronto, Toronto, ON, Canada
Search for more papers by this authorD. Teplin
Faculty of Behavioural Sciences, Yorkville University, Fredericton, NB, Canada
Search for more papers by this authorG. Tomlinson
Department of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, Canada
University Health Network, Toronto, ON, Canada
Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto, ON, Canada
Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
Search for more papers by this authorJ. Daiter
Ontario Addiction Treatment Centres, Richmond Hill, ON, Canada
Search for more papers by this authorM. Krahn
Department of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, Canada
University Health Network, Toronto, ON, Canada
Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto, ON, Canada
Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
Search for more papers by this authorA. John-Baptiste
Department of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, Canada
University Health Network, Toronto, ON, Canada
Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto, ON, Canada
Search for more papers by this authorM. Varenbut
Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
Ontario Addiction Treatment Centres, Richmond Hill, ON, Canada
Search for more papers by this authorM. Lingley
Round Trip Travel Health Clinic, Markham, ON, Canada
Search for more papers by this authorT. Nedd-Roderique
Department of Physiology, University of Toronto, Toronto, ON, Canada
Search for more papers by this authorD. Teplin
Faculty of Behavioural Sciences, Yorkville University, Fredericton, NB, Canada
Search for more papers by this authorG. Tomlinson
Department of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, Canada
University Health Network, Toronto, ON, Canada
Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto, ON, Canada
Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
Search for more papers by this authorJ. Daiter
Ontario Addiction Treatment Centres, Richmond Hill, ON, Canada
Search for more papers by this authorM. Krahn
Department of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, Canada
University Health Network, Toronto, ON, Canada
Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto, ON, Canada
Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
Search for more papers by this authorAbstract
Summary. Substance abusers account for the largest number of hepatitis C infected cases in developed countries. We describe a care model for treating current or former substance abusers with antiviral therapy for hepatitis C virus (HCV) infection. The care model involved hepatitis nurses, a psychologist, infectious disease specialist and primary care physicians. Clients met selection criteria including regular attendance at clinic appointments and social stability. Use of alcohol and illicit substances was monitored with urine toxicology screens. The association between substance use, rates of completion of therapy and rates of response were assessed using multivariable regression analyses. A total of 109 clients (75 with genotype 1/4 and 34 with genotype 2/3) received at least one injection with pegylated interferon between November 2002 and January 2006. Treatment completion rates of 61 and 74% were achieved for genotypes 1/4 and 2/3, respectively. Treatment response rates in an intention to treat analysis were 51% for genotypes 1/4 and 68% for genotypes 2/3. A positive urine toxicology screen indicating use of illicit substances 6 months prior to initiating therapy was significantly associated with lower rates of treatment completion but not lower rates of sustained virological response. A positive urine screen indicating use of alcohol prior to therapy was significantly associated with lower rates of completion and lower rates of response. Rates of completion and response are comparable to non-substance abusing populations. Antiviral therapy for HCV infection can be successful within the context of ongoing care for substance abuse for carefully selected patients.
References
- 1 Bruandet A, Lucidarme D, Decoster A et al. Incidence and risk factors of HCV infection in a cohort of intravenous drug users in the North and East of France [French]. Rev Epidemiol Sante Publique 2006; 54(Suppl. 1): 1S15–1S22.
- 2 Judd A, Hickman M, Jones S et al. Incidence of hepatitis C virus and HIV among new injecting drug users in London: prospective cohort study. BMJ 2005; 330(7481): 24–25.
- 3 Villano SA, Vlahov D, Nelson KE, Lyles CM, Cohn S, Thomas DL. Incidence and risk factors for hepatitis C among injection drug users in Baltimore, Maryland. J Clin Microbiol 1997; 35(12): 3274–3277.
- 4 Miller CL, Spittal PM, Frankish JC, Li K, Schechter MT, Wood E. HIV and hepatitis C outbreaks among high-risk youth in Vancouver demands a public health response. Can J Public Health 2005; 96(2): 107–108.
- 5 Crofts N, Jolley D, Kaldor J, Van Beek I, Wodak A. Epidemiology of hepatitis C virus infection among injecting drug users in Australia. J Epidemiol Community Health 1997; 51(6): 692–697.
- 6 Strathdee SA, Patrick DM, Currie SL et al. Needle exchange is not enough: lessons from the Vancouver injecting drug use study. AIDS 1997; 11(8): F59–F65.
- 7 Mathei C, Buntinx F, Van Damme P. Seroprevalence of hepatitis C markers among intravenous drug users in western European countries: a systematic review. J Viral Hepat 2002; 9(3): 157–173.
- 8 Amon JJ, Garfein RS, Ahdieh-Grant L et al. Prevalence of hepatitis C virus infection among injection drug users in the United States, 1994–2004. Clin Infect Dis 2008; 46(12): 1852–1858.
- 9 Witkos M, Yi QL, Heathcote J, Kapral MK, Krahn MD. Predictors of antiviral therapy in a post-transfusion cohort of hepatitis C patients. Can J Gastroenterol 2006; 20(2): 107–111.
- 10 Grebely J, Genoway K, Khara M et al. Treatment uptake and outcomes among current and former injection drug users receiving directly observed therapy within a multidisciplinary group model for the treatment of hepatitis C virus infection. Int J Drug Policy 2007; 18(5): 437–443.
- 11 Stoove MA, Gifford SM, Dore GJ. The impact of injecting drug use status on hepatitis C-related referral and treatment. Drug Alcohol Depend 2005; 77(1): 81–86.
- 12 Fleming CA, Tumilty S, Murray JE, Nunes D. Challenges in the treatment of patients coinfected with HIV and hepatitis C virus: need for team care. Clin Infect Dis 2005; 40(Suppl 5): S349–S354.
- 13 Grebely J, Genoway KA, Raffa JD et al. Barriers associated with the treatment of hepatitis C virus infection among illicit drug users. Drug Alcohol Depend 2008; 93(1–2): 141–147.
- 14 Schackman BR, Teixeira PA, Weitzman G, Mushlin AI, Jacobson IM. Quality-of-life tradeoffs for hepatitis C treatment: do patients and providers agree? Med Decis Making 2008; 28(2): 233–242.
- 15 Zickmund S, Hillis SL, Barnett MJ, Ippolito L, LaBrecque DR. Hepatitis C virus-infected patients report communication problems with physicians.[see comment]. Hepatology 2004; 39(4): 999–1007.
- 16 Zickmund S, Ho EY, Masuda M, Ippolito L, LaBrecque DR. “They treated me like a leper” Stigmatization and the quality of life of patients with hepatitis C. J Gen Intern Med 2003; 18(10): 835–844.
- 17 Wang P, Yi Q, Scully L, Heathcote J, Krahn M. Indications for interferon/ribavirin therapy in hepatitis C patients: findings from a survey of Canadian hepatologists. Can J Gastroenterol 2003; 17(3): 183–186.
- 18 National Institutes of Health Consensus Development Conference Statement: Management of hepatitis C 2002 (June 10–12, 2002). Gastroenterology 2002; 123(6): 2082–2099.
- 19 Sherman M. Management of viral hepatitis: clinical and public health perspectives--a consensus statement. CASL Hepatitis Consensus Group. Canadian Association for Study of the Liver. Can J Gastroenterol 1997; 11(5): 407–416.
- 20 Robaeys G, Mathei C, Buntinx F, Vanranst M. Management of hepatitis C virus infections in intravenous drug users. Acta Gastroenterol Belg 2002; 65(2): 99–100.
- 21 Grebely J, Conway B, Raffa JD, Lai C, Krajden M, Tyndall MW. Hepatitis C virus reinfection in injection drug users. Hepatology 2006; 44(5): 1139–1145.
- 22 Fischer B, Haydon E, Rehm J, Krajden M, Reimer J. Injection drug use and the hepatitis C virus: considerations for a targeted treatment approach – the case study of Canada. J Urban Health 2004; 81(3): 428–447.
- 23 Broers B, Helbling B, Francois A et al. Barriers to interferon-a therapy are higher in intravenous drug users than in other patients with acute hepatitis C. J Hepatol 2005; 42(3): 323–328.
- 24 Iwasaki Y, Ikeda H, Araki Y et al. Limitation of combination therapy of interferon and ribavirin for older patients with chronic hepatitis C. Hepatology 2006; 43(1): 54–63.
- 25 Sola R, Galeras JA, Montoliu S et al. Poor response to hepatitis C virus (HCV) therapy in HIV- and HCV-coinfected patients is not due to lower adherence to treatment. AIDS Res Hum Retroviruses 2006; 22(5): 393–400.
- 26 Raptopoulou M, Tsantoulas D, Vafiadi I et al. The effect of adherence to therapy on sustained response in daily or three times a week interferon alpha-2b plus ribavirin treatment of naive and nonresponder chronic hepatitis C patients. J Viral Hepat 2005; 12(1): 91–95.
- 27 Castera L, Constant A, Bernard PH, De Ledinghen V, Couzigou P. Psychological impact of chronic hepatitis C: Comparison with other stressful life events and chronic diseases. World J Gastroenterol 2006; 12(10): 1545–1550.
- 28 Manns MP, McHutchison JG, Gordon SC et al. Peginterferon alfa-2b plus ribavirin compared with interferon alfa-2b plus ribavirin for initial treatment of chronic hepatitis C: a randomised trial. Lancet 2001; 358(9286): 958–965.
- 29 R: A Language and Environment for Statistical Computing, R Development Core Team, R Foundation for Statistical Computing, Vienna, Austria, 2005, http://www.R-project.org .
- 30 Sylvestre DL. Treating hepatitis C in methadone maintenance patients: an interim analysis. Drug Alcohol Depend 2002; 67(2): 117–123.
- 31 Backmund M, Meyer K, Von Zielonka M, Eichenlaub D. Treatment of hepatitis C infection in injection drug users. Hepatology 2001; 34(1): 188–193.
- 32 Van Thiel DH, Anantharaju A, Creech S. Response to treatment of hepatitis C in individuals with a recent history of intravenous drug abuse. Am J Gastroenterol 2003; 98(10): 2281–2288.
- 33 Jeffrey GP, MacQuillan G, Chua F et al. Hepatitis C virus eradication in intravenous drug users maintained with subcutaneous naltrexone implants [see comment]. Hepatology 2007; 45(1): 111–117.
- 34 Sylvestre DL, Clements BJ. Adherence to hepatitis C treatment in recovering heroin users maintained on methadone. Eur J Gastroenterol Hepatol 2007; 19(9): 741–747.
- 35 Sylvestre DL, Clements BJ, Malibu Y. Cannabis use improves retention and virological outcomes in patients treated for hepatitis C. Eur J Gastroenterol Hepatol 2006; 18(10): 1057–1063.
- 36 Robaeys G, Van Vlierberghe H, Mathei C, Van Ranst M, Bruckers L, Buntinx F. Similar compliance and effect of treatment in chronic hepatitis C resulting from intravenous drug use in comparison with other infection causes. Eur J Gastroenterol Hepatol 2006; 18(2): 159–166.
- 37 Schaefer M, Schmidt F, Folwaczny C et al. Adherence and mental side effects during hepatitis C treatment with interferon alfa and ribavirin in psychiatric risk groups. Hepatology 2003; 37(2): 443–451.
- 38 Tabone M, Sidoli L, Laudi C et al. Alcohol abstinence does not offset the strong negative effect of lifetime alcohol consumption on the outcome of interferon therapy. J Viral Hepat 2002; 9(4): 288–294.
- 39 Loguercio C, Di Pierro M, Di Marino MP et al. Drinking habits of subjects with hepatitis C virus-related chronic liver disease: prevalence and effect on clinical, virological and pathological aspects. Alcohol Alcohol 2000; 35(3): 296–301.
- 40 Chang A, Skole K, Gautam M et al. The impact of past alcohol use on treatment response rates in patients with chronic hepatitis C. Alimen Pharmacol Therap 2005; 22(8): 701–706.
- 41 Mochida S, Ohnishi K, Matsuo S, Kakihara K, Fujiwara K. Effect of alcohol intake on the efficacy of interferon therapy in patients with chronic hepatitis C as evaluated by multivariate logistic regression analysis. Alcoholism: Clin Exper Res 1996; 20(Suppl. 9): 371A–377A.
- 42 Anand BS, Currie S, Dieperink E et al. Alcohol use and treatment of hepatitis C virus: results of a national multicenter study [see comment]. Gastroenterology 2006; 130(6): 1607–1616.
- 43 Ewart A, Harrison L, Joyner B, Safe A. Providing treatment for hepatitis C in an Australian district centre. Postgrad Med J 2004; 80(941): 180–182.
- 44 Media Release: Minister for Health and Ageing, Australia. February 20, 2006. Available at: http://www.health.gov.au/internet/ministers/publishing.nsf/Content/6E130AAD737A22FFCA25711B000E9BB6/$File/abb019.pdf (accessed 23 July 2008).
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