Management of hepatitis C in active drugs users: experience of an addiction care hepatology unit

Objective - Recent guidelines on the management of patients chronic hepatitis C virus (HCV) infection recommend the same anti-HCV therapy for active intravenous drug users and other patients, however some physicians are reluctant to treat active drug users. The aim of this study was to compare hepatitis C management practices and clinical outcome after treatment between active intravenous drug users and other patients. Methods - Four hundred and thirty-five naive HCV seropositive patients were recruited from 1990 to 2000 and followed up for a mean period of 2.5 years (SD 1 year). At the beginning of the study, 116 of the patients were active intravenous drug users. Social, clinical, biological and histological data were collected. The different steps of HCV management and responses to treatment were compared between active intravenous drug users and other patients. Results - There was no statistically significant difference in HCV management practices and compliance between active intravenous drug users and other patients: search for viral RNA (85% versus 67%), liver biopsy performed when indicated (82% versus 87%), initiation of anti-HCV treatment (33.6% versus 43.2%), loss to follow up during treatment (24% vs 16%). The rate of sustained viral response was not significantly different between active intravenous drug users and other patients (28% versus 21%). At multivariate analysis, factors independently associated with sustained viral response were female gender (OR = 5.6 [1.02-41.2]), genotype 3 (OR = 29.7 [1.4-61.7]), low viral load (OR = 33.3 [2,25-100]), low fibrosis score (OR = 1.4 [1.0-2.0]), elevated transaminase level (OR = 12.7 [0.9-97.2]), and bitherapy protocol (OR = 10 [1.18-85.3]). Conclusion - This study illustrates that active intravenous drug use does not affect either patient compliance with proposed management or viral response to treatment, but pluridisciplinary care should focus both on drug addiction and HCV infection.