Vancouver Hepatitis C Treatment Program for Injection Drug Users Proves Popular and Successful

SUMMARY: An ongoing initiative to offer interferon-based therapy for chronic hepatitis C virus (HCV) infection to injection drug users has demonstrated promising outcomes, according to a study presented at the recent 50th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC 2010) in Boston. Retention in the program has been good despite some patients continuing active drug use, and about half of those who underwent treatment have achieved sustained virological response (SVR).

By Liz Highleyman

Some healthcare providers have traditionally been reluctant to offer chronic hepatitis C treatment to current or former injection drug users due to concerns about poor adherence and toxicities. Studies have shown, however, that such patients can do well on treatment, and current practice guidelines state that drug users should be considered on an individual basis and not routinely excluded from therapy.

B. Conway from the University of British Columbia and colleagues performed an evaluation of a program providing hepatitis C treatment to injection drug users in Vancouver's Downtown East Side neighborhood.

Starting in March 2005, participants were recruited at the Pender Community Health Centre and evaluated for possible treatment for HCV infection. Diagnostic testing was offered for HCV and HIV, and patients who were deemed eligible for hepatitis C therapy were offered the opportunity to be included in the program.

Participants attended weekly clinic visits. All treated patients received once-weekly pegylated interferon as directly observed therapy plus daily self-administered ribavirin. Participants also received extensive medical, addiction, and counseling support and a standardized proactive approach to management of treatment-related side effects.

Results

• At the time the study abstract was submitted, 370 potential participants had been screened and 165 courses of treatment were administered.
• Most participants (84%) were men, the mean age was 49 years, 52% had hard-to-treat HCV genotype 1, and 10% were coinfected with HIV.
• 53% reported injection drug use within the previous 30 days.
• Willingness to undergo hepatitis C treatment was positively associated with male sex (adjusted odds ratio [aOR] 3.73) and current enrollment in an opiate substitution pharmacotherapy program (aOR 1.63).
• Combined drug use was associated with less willingness to start therapy (aOR 0.36).
• Among treated participants with an appropriate duration of follow-up, the SVR rate 24 weeks after finishing treatment was 54%:

          --HCV genotype 1: 39%;
          --HCV genotype 2: 75%;
          --HCV genotype 3: 63%.

• Type of pegylated interferon (Pegasys or PegIntron) and HIV coinfection status were not associated with virological treatment failure. 

"Our expanding program (to deliver over 100 courses of treatment per year in 2010) continues to attract significant numbers of patients into HCV treatment, with good retention and success, despite ongoing illicit drug use in many cases," the researchers concluded. "The flexibility of the program allows us to tailor its delivery to suit individual needs and contributes to its success."

Investigator affiliations: Univ. of British Columbia, Vancouver, Canada; Vancouver Coastal Health, Vancouver, Canada.

9/28/10

Reference
B Conway, L Gallagher, E Knight, and others. Treatment of HCV Infection in Injection Drug Users (IDUs): An Update on a Multidisciplinary Program in Vancouver. 50th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC 2010). Boston, September 12-15, 2010. Abstract V-1790.

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