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Injection drug users reach SVR with HCV dual antiviral therapy

Injection drug users with hepatitis C virus infection appeared to be good candidates for antiviral therapy, after a majority achieved a sustained virologic response with treatment with pegylated interferon and ribavirin, according to a study published in Annals of Hepatology.

In a retrospective study, researchers analyzed data of 204 patients with HCV and cirrhosis assigned a treatment regimen of pegylated interferon and ribavirin between 2008 and 2011 in Southern Italy. Of all the patients, 112 were injection drug users (IDUs) and 92 were not. The patients who were IDUs were mostly young men and had a prevalence of HCV genotype 3 infection, according to the research.    

In a per protocol analysis, IDUs achieved a higher sustained virologic response (SVR) rate compared with the non-IDUs (90% vs. 78.9%; P = .04). However, in an intention-to-treat analysis, there were no significant differences between the two groups. A higher SVR was observed in the intention-to-treat analysis in naive patients who were not IDUs compared with the other patients (90% vs. 13%; P = .021), but was unconfirmed in a per-protocol analysis.   

The only independent factor associated with SVR for successful HCV therapy was rapid virologic response (RVR; OR = 7.488; 95% CI, 3.32-16.982); a higher RVR independently and significantly increased the odds ratio of an SVR, according to the research.

The treatment regimen was well tolerated in all patients. Common adverse events were depression, asthenia and anemia. IDUs had a higher dropout rate compared with the non-IDUs (24 vs. 2 patients). Approximately 13% of IDUs discontinued treatment and then relapsed.

“Although no international treatment guidelines are available for the management of HCV infection among IDUs, the results of our observational study show that IDUs naive patients, appear to be good candidates and very good responders to a standard antiviral combination of ribavirin and pegylated interferon alpha with high prevalence of SVR,” the researchers concluded. “This finding suggests that the proportion of IDUs who start treatment for HCV infection should be increased and dual therapy might still be considered a real strategic option for them.” – by Melinda Stevens

Disclosure: The researchers report no relevant financial disclosures.