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Drug Users With Hepatitis C Virus Can Achieve a Sustained Virologic Response With Standard Treatment: Presented at AASLD

By Maria Bishop

BOSTON, MA -- November 5, 2007 -- Current and former illicit drug users who have hepatitis C virus (HCV) are able to achieve a sustained virologic response (SVR) with standard treatment, according to research presented here at the 58th Annual Meeting of the American Association for the Study of Liver Diseases (AASLD).

In developed nations, intravenous drug users (IDUs) account for over 50% of prevalent and over 75% of incident HCV infection, noted Jason Grebely, PhD, Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada. In many centres, it is recommended that IDUs not receive HCV treatment on the basis that adherence, psychological side effects, and re-infection may pose barriers to treatment.

Dr. Grebely led a team of colleagues in an open-label, prospective observational trial of 51 non-cirrhotic subjects with HCV who were current or former illicit drug users for whom HCV treatment was initiated.

Overall, 28 of the 51 subjects (55%) receiving IFN alfa-2b (n = 12), PEG-IFN alfa-2b (n = 32), or PEG-IFN alfa-2a (n = 7) for 24 or 48 weeks (depending on genotype) achieved an SVR.

Illicit drugs were used by 21 of the 51 subjects (41%) in the 6 months preceding therapy, and by 29 of 51 (57%) during treatment.

Following SVR, 28 subjects were followed for a mean of 1.1 years (range, 0 to 3.2 years). In this period, 13 of the 28 patients (46%) reported using illicit drugs (3: injection heroin/cocaine and crack cocaine, 2: injection heroin and crack cocaine, 1: injection cocaine and crack cocaine, 3: injection cocaine, 2: injection heroin, 2: crack cocaine).

At the outset of this study, all subjects had a reasonable expectation of adherence to therapy. Subjects attended the clinic weekly. Ribavirin was self-administrated, while interferon alfa 2b and pegylated interferon alfa 2a or 2b were administered by nurses as direct observed therapy.

Dr. Grebely concluded that there is certainly a rationale for expanding treatment in this group, but that research is required to understand whether the success in this population is associated with protective immunity against HCV re-infection or reduced risk behaviors for acquisition following successful treatment.

This study was supported by the National Canadian Research Training Program in Hepatitis C, the Canadian Institutes for Health Research, Vancouver Coastal Health and the Vancouver Foundation.


[Presentation title: Infrequent Hepatitis C Virus (HCV) Re-infection after Sustained Virological Response (SVR) Among Current and Former Injection Drug Users (IDUs) Having Received Treatment for HCV Infection. Abstract 296]

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