Community-based treatment for chronic hepatitis C in drug users: high rates of compliance with therapy despite ongoing drug use

[Guest guest]

http://www3.interscience.wiley.com/journal/121387874/abstract?CRETRY=1 & SRETRY=0

Alimentary Pharmacology & Therapeutics

Volume 29 Issue 1, Pages 29 - 37

Published Online: 26 Aug 2008

Community-based treatment for chronic hepatitis C in drug users: high rates of

compliance with therapy despite ongoing drug use

M. WILKINSON*, V. CRAWFORD*, A. TIPPET*, F. JOLLY*, J. TURTON*, E. SIMS*, M.

HEKKER*, J. DALTON*, R. MARLEY† & G. R. FOSTER†

*Specialist Addiction Unit, East London NHS Foundation Trust ; and

†Hepatology, Institute of Cellular and Molecular Science, Barts and The London

School of Medicine, The Royal London Hospital, London, UK

Correspondence to Prof. G. R. , ICMS, Barts and The London School of

Medicine, The Royal London Hospital, 4 Newark Street, E1 4AT London, UK.

E-mail: g.r.foster@...

Copyright Journal compilation © 2008 Blackwell Publishing Ltd

ABSTRACT

Background Chronic hepatitis C infection is common in drug users. Treatment of

injectors is possible under controlled conditions, but many have not yet been

included in treatment programmes as there are concerns about their ability to

comply with therapy. It is not known which factors influence compliance.

Aim To examine the hypothesis that active drug users would comply with

anti-viral therapy if treatment was delivered in a convenient manner.

Methods We established a community-based treatment programme and offered

anti-viral therapy to all drug users who wanted it. Few pre-treatment

requirements were imposed and, by design, compliance with therapy was reviewed

after 50 patients had completed treatment.

Results Of the 441 patients who were known to be HCV RNA positive and attended

the specialist addiction services during the period of this study, eighty three

patients considered therapy. Twenty patients did not undergo treatment: 14

declined and 6 had medical conditions that precluded it. In 60 episodes (58

patients) where treatment had been completed, compliance was greater than 80%

and homelessness, active illicit drug use and pre-treatment antidepressant

therapy were not associated with noncompliance. In 25 of 49 treatment episodes

that were assessed 6 months after treatment cessation, a sustained virological

response (51%) was seen.

Conclusion Active drug users using illicit drugs can be successfully treated in

community-based clinics.

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Publication data Submitted 12 May 2008 First decision 13 June 2008 Resubmitted

24 June 2008 Resubmitted 18 July 2008 Accepted 17 August 2008 Epub Accepted

Article 26 August 2008

DIGITAL OBJECT IDENTIFIER (DOI)

10.1111/j.1365-2036.2008.03834.x

[Guest guest]

http://www3.interscience.wiley.com/journal/121387874/abstract?CRETRY=1 & SRETRY=0

Alimentary Pharmacology & Therapeutics

Volume 29 Issue 1, Pages 29 - 37

Published Online: 26 Aug 2008

Community-based treatment for chronic hepatitis C in drug users: high rates of

compliance with therapy despite ongoing drug use

M. WILKINSON*, V. CRAWFORD*, A. TIPPET*, F. JOLLY*, J. TURTON*, E. SIMS*, M.

HEKKER*, J. DALTON*, R. MARLEY† & G. R. FOSTER†

*Specialist Addiction Unit, East London NHS Foundation Trust ; and

†Hepatology, Institute of Cellular and Molecular Science, Barts and The London

School of Medicine, The Royal London Hospital, London, UK

Correspondence to Prof. G. R. , ICMS, Barts and The London School of

Medicine, The Royal London Hospital, 4 Newark Street, E1 4AT London, UK.

E-mail: g.r.foster@...

Copyright Journal compilation © 2008 Blackwell Publishing Ltd

ABSTRACT

Background Chronic hepatitis C infection is common in drug users. Treatment of

injectors is possible under controlled conditions, but many have not yet been

included in treatment programmes as there are concerns about their ability to

comply with therapy. It is not known which factors influence compliance.

Aim To examine the hypothesis that active drug users would comply with

anti-viral therapy if treatment was delivered in a convenient manner.

Methods We established a community-based treatment programme and offered

anti-viral therapy to all drug users who wanted it. Few pre-treatment

requirements were imposed and, by design, compliance with therapy was reviewed

after 50 patients had completed treatment.

Results Of the 441 patients who were known to be HCV RNA positive and attended

the specialist addiction services during the period of this study, eighty three

patients considered therapy. Twenty patients did not undergo treatment: 14

declined and 6 had medical conditions that precluded it. In 60 episodes (58

patients) where treatment had been completed, compliance was greater than 80%

and homelessness, active illicit drug use and pre-treatment antidepressant

therapy were not associated with noncompliance. In 25 of 49 treatment episodes

that were assessed 6 months after treatment cessation, a sustained virological

response (51%) was seen.

Conclusion Active drug users using illicit drugs can be successfully treated in

community-based clinics.

--------------------------------------------------------------------------------

Publication data Submitted 12 May 2008 First decision 13 June 2008 Resubmitted

24 June 2008 Resubmitted 18 July 2008 Accepted 17 August 2008 Epub Accepted

Article 26 August 2008

DIGITAL OBJECT IDENTIFIER (DOI)

10.1111/j.1365-2036.2008.03834.x