Summary
This scientific article was one of the 2011 EMCDDA scientific award winners, which celebrates scientific writing and distinguishes high-quality research in the field of illicit drugs.
Abstract
Background:
Severely opioid-dependent patients are at high risk of both acquiring and spreading the hepatitis C virus (HCV). It is uncertain, however, whether these patients are possible candidates for HCV treatment. We therefore explored treatment retention and adherence as well as sustained viral response in co-morbid severely opioid-dependent subjects under heroin maintenance, who previously failed in conventional substitution treatment or were not in any drug treatment.
Methods:
All patients in heroin maintenance in the German heroin trial, who received standard antiviral HCV therapy with pegylated interferon and ribavirin, were included. Co-consumption of licit and illicit drugs was tolerated as long as it did not interfere with treatment.
Results:
Twenty-six patients in heroin maintenance were treated for chronic HCV infection. Both the Global Severity Index of the Symptom Checklist 90-R (average score 65.9) and the Opiate Treatment Index (average score 16.6) indicated relevant co-morbidity. Twenty-one patients (81 %) were retained in treatment; the adherence rate was 92 %. Eighteen patients (69 %) achieved a sustained viral response, with a 100 % response rate for genotype 2, 90 % for genotype 3, and 42 % for genotype 1.
Discussion:
This is the first study that investigates the feasibility of antiviral HCV treatment in a well-defined sample of co-morbid severely opioid-dependent subjects in heroin maintenance treatment. Viral response rates are comparable to non-drug-user populations. Within a needadapted treatment setting, HCV treatment may even be extended to difficult-to-treat opioiddependent patients.
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