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HEPATITIS C AND ADDICTION: Retention rate and side effects in a prospective trial on hepatitis C treatment with pegylated interferon alpha‐2a and ribavirin in opioid‐dependent patients
Author(s) -
Ebner Nina,
Wanner Christian,
Winklbaur Bernadette,
Matzenauer Christian,
Jachmann Crispa Aeschbach,
Thau Kenneth,
Fischer Gabriele
Publication year - 2009
Publication title -
addiction biology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.445
H-Index - 78
eISSN - 1369-1600
pISSN - 1355-6215
DOI - 10.1111/j.1369-1600.2009.00148.x
Subject(s) - medicine , ribavirin , hepatitis c , pegylated interferon , randomized controlled trial , adverse effect , buprenorphine , depression (economics) , alpha interferon , gastroenterology , opioid , hepatitis c virus , immunology , interferon , virus , receptor , economics , macroeconomics
Hepatitis C viral (HCV) infection is present in 30 to 98% of intravenous drug users. Intravenous substance abuse represents the main route of HCV transmission in industrialized countries. A multi‐centre, randomized, controlled, prospective study assessed sustained virological response (SVR), adverse events such as depressive episodes and retention rate of HCV treatment in opioid‐dependent patients. Stabilized, opioid‐dependent patients with chronic HCV infection (genotype 2 or 3) received pegylated interferon alpha‐2a in combination with ribavirin 800 mg/day (Group A) or 400 mg/day (Group B). Participants were randomized, blocked and stratified by genotype and viral load. A standardized psychiatric assessment, Beck Depression Inventory (BDI) and Van Zerssen's list of complaints were administered at each study visit. In 31 months, 300 opioid‐dependent patients were screened; 190 (63.3%) were hepatitis C antibody positive. According to study protocol, out of 75 ‘potential‐to‐treat’ patients with genotype 2 or 3, 17 stable patients (22.6%) were included in the study. All participants completed the study. Significant haemoglobin decreases occurred in both Groups A ( P = 0.001) and B ( P = 0.011). All the patients had an end‐of‐treatment (week 24) HCV RNA negativity. Fifteen (88.2%) achieved SVR at week 48. Overall, 52.9% developed depressive symptoms during treatment. Because of the prompt initiation of antidepressant medication at first appearance of depressive symptoms, no severe depressive episodes occurred. Our data show a high retention rate and reliability, and good viral response for both treatments. Hepatitis C treatment in stable opioid‐dependent patients was efficacious, suggesting that addiction clinics can offer antiviral therapy in combination with agonistic treatment as part of multi‐disciplinary treatment.