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Treatment of intravenous drug users with chronic hepatitis C: treatment response, compliance and side effects.

BACKGROUND
Although intravenous drug users (IVDUs) comprise the majority of patients with chronic hepatitis C, most of them are excluded from treatment because of concerns about adherence to treatment and side effects.


MATERIAL AND METHODS
In this study we retrospectively evaluated safety, compliance to treatment and efficacy of treatment in IVDUs with HCV infection in 163 former IVDUs with chronic hepatitis C, who were not in methadone substitution and were attending our clinics the period 1997-2004. All subjects were HCVRNA (+), had ALT levels>x1.5 UNL and were treated for their HCV infection. Treatment consisted of three different regimens: IFN-alpha monotherapy (39.8%), IFN-alpha/ribavirin combination therapy (30.1%) and pegylated IFN-alpha/ribavirin combination therapy.


RESULTS
Eighty seven over 163 patients (53.3%) discontinued treatment early due to drug abuse relapse (62%), side effects (32.1%, 10% psychiatric) and 5,7% for other reasons. Eighty precent of those who discontinued treatment had pre-treatment drug abstinence<or=9 months. Seventy over 76 patients who completed therapy had an end-of-treatment virologic response (ETR, 92%). Fifty four over 76 patients showed sustained virologic response (SVR, 71.05%). ETR and SVR were significantly higher in both combination therapies compared to IFN-alpha monotherapy. The most prevalent HCV genotype was 3 (65%) and mild histological lesions were detected in the majority of subjects.


CONCLUSIONS
Our findings show that treatment for chronic hepatitis C was reasonably safe and sufficiently effective in our group of non methadone-substituted IVDUs, despite the fact that more than half of them discontinued treatment early and many relapsed to drug abuse. We suggest that the optimal duration of pretreatment abstinence from drug abuse should be >/= 9 months.