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Efficacy of chronic hepatitis C therapy with pegylated interferon and ribavirin in patients on methadone maintenance treatment

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Abstract

A considerable number of patients undergoing methadone maintenance treatment (MMT) are not considered for treatment against hepatitis C virus (HCV) infection due to a possible lower adherence and efficacy in this population. We aimed to compare the response rates to HCV treatment in patients with or without MMT. HCV-infected patients who initiated pegylated interferon plus ribavirin were included in this prospective cohort study. The relation between sustained virologic response (SVR) and MMT was analyzed. A total of 214 patients were included in the study [81 (37.9%) with and 133 (62.1%) without MMT]. No differences in HCV and interleukin 28B (rs12979860) genotype distribution were observed between the two groups. Of these patients, 103 (48.1%) achieved SVR. Among the patients who received MMT, 39 (48.1%) reached SVR compared to 64 (48.1%) subjects without MMT (p = 0.99). The frequency of voluntary drop-out and treatment discontinuations due to adverse events was comparable between the patients with and without MMT [10 (12.3%) versus 14 (10.5%), p = 0.68, and 4 (4.9%) versus 9 (6.8%), p = 0.59, respectively]. The efficacy of HCV therapy in MMT patients is similar to that found in subjects not taking methadone. MMT patients should be equally considered for treatment with pegylated interferon plus ribavirin in HCV-infected patients.

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References

  1. Alter MJ (2002) Prevention of spread of hepatitis C. Hepatology 36:S93–S98

    Article  PubMed  Google Scholar 

  2. Armstrong GL, Wasley A, Simard EP, McQuillan GM, Kuhnert WL, Alter MJ (2006) The prevalence of hepatitis C virus infection in the United States, 1999 through 2002. Ann Intern Med 144:705–714

    PubMed  Google Scholar 

  3. Aceijas C, Rhodes T (2007) Global estimates of prevalence of HCV infection among injecting drug users. Int J Drug Policy 18:352–358

    Article  PubMed  Google Scholar 

  4. Sulkowski MS, Thomas DL (2005) Epidemiology and natural history of hepatitis C virus infection in injection drug users: implications for treatment. Clin Infect Dis 40(Suppl 5):S263–S269

    Article  PubMed  Google Scholar 

  5. Hellard M, Sacks-Davis R, Gold J (2009) Hepatitis C treatment for injection drug users: a review of the available evidence. Clin Infect Dis 49:561–573

    Article  PubMed  Google Scholar 

  6. Zeiler I, Langlands T, Murray JM, Ritter A (2010) Optimal targeting of hepatitis C virus treatment among injecting drug users to those not enrolled in methadone maintenance programs. Drug Alcohol Depend 110:228–233

    Article  PubMed  Google Scholar 

  7. Mehta SH, Genberg BL, Astemborski J, Kavasery R, Kirk GD, Vlahov D et al (2008) Limited uptake of hepatitis C treatment among injection drug users. J Community Health 33:126–133

    Article  PubMed  Google Scholar 

  8. Hatem C, Minello A, Bresson-Hadni S, Jooste V, Evrard P, Obert B et al (2005) Is the management of hepatitis C patients appropriate? A population-based study. Aliment Pharmacol Ther 21:1007–1015

    Article  PubMed  CAS  Google Scholar 

  9. Mathers BM, Degenhardt L, Ali H, Wiessing L, Hickman M, Mattick RP et al (2010) HIV prevention, treatment, and care services for people who inject drugs: a systematic review of global, regional, and national coverage. Lancet 375:1014–1028

    Article  PubMed  Google Scholar 

  10. Novick DM, Kreek MJ (2008) Critical issues in the treatment of hepatitis C virus infection in methadone maintenance patients. Addiction 103:905–918

    Article  PubMed  Google Scholar 

  11. Schaefer M, Heinz A, Backmund M (2004) Treatment of chronic hepatitis C in patients with drug dependence: time to change the rules? Addiction 99:1167–1175

    Article  PubMed  Google Scholar 

  12. Robaeys G, Buntinx F (2005) Treatment of hepatitis C viral infections in substance abusers. Acta Gastroenterol Belg 68:55–67

    PubMed  CAS  Google Scholar 

  13. Farley J, Vasdev S, Fischer B, Haydon E, Rehm J, Farley TA (2005) Feasibility and outcome of HCV treatment in a Canadian federal prison population. Am J Public Health 95:1737–1739

    Article  PubMed  Google Scholar 

  14. Schaefer M, Hinzpeter A, Mohmand A, Janssen G, Pich M, Schwaiger M et al (2007) Hepatitis C treatment in “difficult-to-treat” psychiatric patients with pegylated interferon-alpha and ribavirin: response and psychiatric side effects. Hepatology 46:991–998

    Article  PubMed  CAS  Google Scholar 

  15. Krook AL, Stokka D, Heger B, Nygaard E (2007) Hepatitis C treatment of opioid dependants receiving maintenance treatment: results of a Norwegian pilot study. Eur Addict Res 13:216–221

    Article  PubMed  Google Scholar 

  16. Waizmann M, Ackermann G (2010) High rates of sustained virological response in hepatitis C virus-infected injection drug users receiving directly observed therapy with peginterferon alpha-2a (40KD) (PEGASYS) and once-daily ribavirin. J Subst Abuse Treat 38:338–345

    Article  PubMed  Google Scholar 

  17. Sylvestre DL (2005) Treating hepatitis C virus infection in active substance users. Clin Infect Dis 40(Suppl 5):S321–S324

    Article  PubMed  Google Scholar 

  18. Belfiori B, Ciliegi P, Chiodera A, Bacosi D, Tosti A, Baldelli F et al (2009) Peginterferon plus ribavirin for chronic hepatitis C in opiate addicts on methadone/buprenorphine maintenance therapy. Dig Liver Dis 41:303–307

    Article  PubMed  CAS  Google Scholar 

  19. Mauss S, Berger F, Goelz J, Jacob B, Schmutz G (2004) A prospective controlled study of interferon-based therapy of chronic hepatitis C in patients on methadone maintenance. Hepatology 40:120–124

    Article  PubMed  CAS  Google Scholar 

  20. Bonkovsky HL, Tice AD, Yapp RG, Bodenheimer HC Jr, Monto A, Rossi SJ et al (2008) Efficacy and safety of peginterferon alfa-2a/ribavirin in methadone maintenance patients: randomized comparison of direct observed therapy and self-administration. Am J Gastroenterol 103:2757–2765

    Article  PubMed  CAS  Google Scholar 

  21. European Association for the Study of the Liver (EASL). Home page at: http://www.easl.eu. Accessed March 10th, 2011

  22. European AIDS Clinical Society (EACS) Guidelines: clinical management and treatment of chronic hepatitis B and C coinfection in HIV-infected adults. Available online at: http://www.europeanaidsclinicalsociety.org/images/stories/EACS-Pdf/3_chronic_hepatitis_b__c.pdf. Accessed March 10th, 2011

  23. Sánchez-Tapias JM, Diago M, Escartín P, Enríquez J, Romero-Gómez M, Bárcena R et al (2006) Peginterferon-alfa2a plus ribavirin for 48 versus 72 weeks in patients with detectable hepatitis C virus RNA at week 4 of treatment. Gastroenterology 131:451–460

    Article  PubMed  Google Scholar 

  24. Torriani FJ, Rodríguez-Torres M, Rockstroh JK, Lissen E, González-García J, Lazzarin A et al (2004) Peginterferon alfa-2a plus ribavirin for chronic hepatitis C virus infection in HIV-infected patients. N Engl J Med 351:438–450

    Article  PubMed  CAS  Google Scholar 

  25. Pineda JA, Mira JA, Gil de los Santos I, Valera-Bestard B, Rivero A, Merino D et al (2007) Influence of concomitant antiretroviral therapy on the rate of sustained virological response to pegylated interferon plus ribavirin in hepatitis C virus/HIV-coinfected patients. J Antimicrob Chemother 60:1347–1354

    Article  PubMed  CAS  Google Scholar 

  26. Pineda JA, Caruz A, Rivero A, Neukam K, Salas I, Camacho A et al (2010) Prediction of response to pegylated interferon plus ribavirin by IL28B gene variation in patients coinfected with HIV and hepatitis C virus. Clin Infect Dis 51:788–795

    Article  PubMed  CAS  Google Scholar 

  27. Akuta N, Suzuki F, Kawamura Y, Yatsuji H, Sezaki H, Suzuki Y et al (2007) Predictive factors of early and sustained responses to peginterferon plus ribavirin combination therapy in Japanese patients infected with hepatitis C virus genotype 1b: amino acid substitutions in the core region and low-density lipoprotein cholesterol levels. J Hepatol 46:403–410

    Article  PubMed  CAS  Google Scholar 

  28. Vickerman P, Martin N, Hickman M (2011) Can hepatitis C virus treatment be used as a prevention strategy? Additional model projections for Australia and elsewhere. Drug Alcohol Depend 113:83–85

    Article  PubMed  Google Scholar 

  29. Schmidt F, Janssen G, Martin G, Lorenz R, Loeschke K, Soyka M et al (2009) Factors influencing long-term changes in mental health after interferon-alpha treatment of chronic hepatitis C. Aliment Pharmacol Ther 30:1049–1059

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgment

This study has been supported, in part, by grants from the Spanish Health Ministry (ISCIII-RETIC RD06/006), the Fundación Progreso y Salud of the Consejería de Salud de la Junta de Andalucía (PI-0247-2010), and the Fondo de Investigaciones Sanitarias (PI10/01664). K.N. is the recipient of a “Sara Borrell” postdoctoral perfection grant from the Instituto de Salud Carlos III (SCO/523/2008). J.A.P. is the recipient of an intensification grant from the Fundación Progreso y Salud of the Consejería de Salud de la Junta de Andalucia (reference AI-0021).

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Authors and Affiliations

  1. Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Avda. de Bellavista, 41014, Sevilla, Spain

    K. Neukam, J. A. Mira, I. Gilabert, C. Cifuentes, S. García-Rey, N. Merchante, J. Macías & J. A. Pineda

  2. Ambulatory Care Centre for Drug Addiction ANTARIS, Dos Hermanas, Spain

    E. Claro

  3. Medical Services, Centro Penitenciario Sevilla, Alcalá de Guadaira, Spain

    M. J. Vázquez

  4. Unit of Investigation, Hospital Universitario de Valme, Seville, Spain

    C. Almeida

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  1. K. Neukam
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  2. J. A. Mira
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  3. I. Gilabert
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  4. E. Claro
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  5. M. J. Vázquez
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  6. C. Cifuentes
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  7. S. García-Rey
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  8. N. Merchante
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  9. C. Almeida
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  11. J. A. Pineda
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Correspondence to J. A. Pineda.

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Neukam, K., Mira, J.A., Gilabert, I. et al. Efficacy of chronic hepatitis C therapy with pegylated interferon and ribavirin in patients on methadone maintenance treatment. Eur J Clin Microbiol Infect Dis 31, 1225–1232 (2012). https://doi.org/10.1007/s10096-011-1433-5

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  • DOI: https://doi.org/10.1007/s10096-011-1433-5

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