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Multicenter Study
. 2010 Jan;138(1):123-35.e1-2.
doi: 10.1053/j.gastro.2009.09.019. Epub 2009 Sep 24.

Effective treatment of injecting drug users with recently acquired hepatitis C virus infection

Gregory J Dore  1 , Margaret Hellard, Gail V Matthews, Jason Grebely, Paul S Haber, Kathy Petoumenos, Barbara Yeung, Philippa Marks, Ingrid van Beek, Geoffrey McCaughan, Peter White, Rosemary French, William Rawlinson, Andrew R Lloyd, John M Kaldor; Australian Trial In Acute Hepatitis C Study Group
Collaborators, Affiliations
Multicenter Study

Effective treatment of injecting drug users with recently acquired hepatitis C virus infection

Gregory J Dore et al. Gastroenterology. 2010 Jan.

Abstract

Background & aims: Patients with acute hepatitis C virus (HCV) infection who receive treatment achieve high rates of sustained virologic response (SVR), but few studies have examined outcomes among injecting drug users (IDUs). We evaluated the efficacy of treatment of recent HCV infection in IDUs with acute and early chronic HCV.

Methods: We analyzed data from the Australian Trial in Acute Hepatitis C-a prospective study of the natural history and treatment outcomes of patients with recent HCV infection. Participants eligible for the study had their first anti-HCV antibody-positive test result within the past 6 months and either acute clinical HCV within the past 12 months or documented anti-HCV seroconversion within 24 months. Participants with HCV received pegylated interferon-alfa-2a (180 microg/wk, n = 74); those with HCV/human immunodeficiency virus (HIV) co-infection received pegylated interferon-alfa-2a (180 microg/wk) with ribavirin (n = 35) for 24 weeks.

Results: From June 2004 to February 2008, 167 participants were enrolled in the Australian Trial in Acute Hepatitis C; 79% had injected drugs in the previous 6 months. Among 74 with only HCV, the SVRs were 55% and 72% by intention-to-treat and per-protocol analysis, respectively. In multivariate analyses, baseline factors independently associated with lower SVR included decreased social functioning and current opiate pharmacotherapy. Adherent participants had higher SVR rates (63% vs 29%; P = .025). Of the 35 participants with HCV/HIV co-infection, the SVRs were 74% and 75% by intention-to-treat and per-protocol analysis, respectively.

Conclusions: Treatment of recent HCV infection among IDUs, including those with HIV co-infection, is effective. Strategies to engage socially marginalized individuals and increase adherence should improve treatment outcomes in this population.

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Figures

Figure 1
Figure 1
Overview of study population. At least 1 dose of PEG-IFN was administered to 111 participants. Two HCV/HIV co-infected participants received PEG-IFN monotherapy (both non-responders) prior to a protocol amendment in which HCV/HIV participants then received PEG-IFN and ribavirin combination therapy.
Figure 2
Figure 2
Overview of HCV mono-infected participant population.
Figure 3
Figure 3
Response rates in A) HCV mono-infected participants and B) HCV/HIV co-infected participants in the total study population (intent-to-treat) and per-protocol population.
Figure 4
Figure 4
Time to HCV RNA clearance among treated and untreated participants in ATAHC study
See this image and copyright information in PMC

References

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