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Addiction treatment during HCV therapy improved outcomes in illicit drug users

Illicit drug users with hepatitis C were more likely to complete and benefit from treatment when also treated for addiction and seen by a multidisciplinary team of health care providers in a recent study.

Researchers performed a meta-analysis of 36 studies including 2,866 current or former illicit drug users (DUs) with hepatitis C. All participants were treated with pegylated interferon and ribavirin (PEG-INF/RBV), and all included studies produced data on sustained virologic response (SVR).

After removing four outlying studies for publication bias, investigators calculated a pooled SVR rate of 55.5%. Factors influencing SVR rate in multivariate analysis incorporating 19 studies included use of a multidisciplinary team (P<.0001), which was positively associated with SVR, and infection with HCV genotypes 1 or 4 (P=.0003), which was negatively associated. A nonsignificant negative correlation also was observed between SVR and HIV coinfection (P=.19).

Among 32 studies with evaluable data, 83.4% of participants completed HCV treatment. A significantly higher completion rate was observed among patients treated for addiction (P<.0001) across 19 studies evaluating patients who were and were not treated for addiction during HCV therapy. Multivariate analysis of data from 17 evaluable studies indicated associations between lower completion rates and HIV coinfection and male sex, as well as an association between higher completion rates and involvement with support services during HCV therapy (P<.0001 for all).

Rositsa B. Dimova

“Published data suggest that the overall rates for treatment completion and sustained response for PEG-IFN/RBV–treated DUs are comparable to the rates from registration trials in the general population,” Rositsa B. Dimova, PhD, research associate at Weill Cornell Medical College, told Healio.com. “We recommend that DUs treated for addiction should be considered for HCV treatment under the same circumstances as the non-DUs. Given the multiple comorbidities and complexities of dealing with this population, special interventions may be required to enable this population to withstand treatment.”

Disclosure: See the study for a full list of relevant disclosures.