P21 Actively injecting drug users can be successfully treated with antiviral therapy for HCV, are unlikely to be re-infected, and significantly reduce their illicit drug use

Abstract

Purpose: To assess the treatment outcomes and the impact of antiviral therapy on illicit drug use in injecting drug users (IDU's) treated with pegylated interferon and ribavirin for Hepatitis C virus (HCV) by nurses based in community addiction services in North East London. We present the first 81 patients to be treated by this service, 48 of whom were using illicit drugs at the start of treatment making this the largest cohort of active injecting drug users treated for HCV that has been presented to date. Methods: Methods consisted of a retrospective database analysis. Illicit drug use was quantified as 3 (heavy/ daily); 2 (weekly/ moderate); 1 (monthly/occasional) and 0 (previous drug use). The Wilcoxon signed rank test was used for statistical analysis. Results: 81 patients were treated over a 45 month period from September 2004 to January 2009. 50 (62%) were genotype 2/3, and 31 (38%) were genotype 1. The average age of infection with HCV was 23, of diagnosis was 39 and of treatment was 41. Compliance with treatment was 88%. 63% of patients had a sustained viral response, 18% were nonresponders and 10% discontinued treatment early due to side effects. 5 patients (6%) relapsed after successful treatment. Only 1 patient (1%) has been re-infected post treatment. 48 patients (60%) were actively using illicit drugs when HCV treatment was initiated. Data on pre and post treatment intravenous heroin use, crack cocaine use and alcohol use was available in 74, 40 and 21 patients respectively. Intravenous heroin use reduced from 41/74 patients (55%) to 27/74 (36%) (p = 0.0033) after treatment, with daily use reducing from 16/74 (22%) to 7/74 (9%) Crack cocaine use reduced from 32/40 (80%) to 21/40 (53%) (p=0.0103) Alcohol use reduced from 15/21 (71%) to 13/21 (62%) (p=0.5775) Conclusion: Nurse led provision of antiviral therapy for HCV infected injecting drug users in community based clinics is effective, with sustained viral response (SVR) rates that compare favourably with published randomised controlled trials of pegylated interferon and ribavirin[1]. High rates of compliance are seen and reinfection rates are low, so concern over compliance and reinfection should not prevent treatment of injecting drug users. This study has shown for the first time that a significant reduction in illicit drug use occurs during and after antiviral therapy demonstrating a social benefit of treatment in addition to the known health benefits. References: 1)Fried MW, Shiffman ML, Reddy KR. Peginterferon alfa-2a plus ribavirin for chronic Hepatitis C virus infection.