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Treating Hepatitis C in Recovering Injection Drug Users on Methadone

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  • claudine intexas
    NATAP - www.natap.org Treating Hepatitis C in Recovering Injection Drug Users on Methadone Reported by Jules Levin Despite the high prevalence of HCV in
    Message 1 of 2 , Aug 3, 2001
      NATAP - www.natap.org

      Treating Hepatitis C in Recovering Injection Drug
      Users on Methadone
      Reported by Jules Levin

      Despite the high prevalence of HCV in recovering
      injection drug users,
      there
      is little data on the safety, tolerability, and
      efficacy of combination
      interferon/ribavirin therapy in this group. This study
      presented at DDW
      (May
      2001) reports on the experience of treating persons on
      Methadone
      Maintenance
      using an educational support model for the patients.
      The authors report
      that
      the preliminary viral response rates to therapy, and
      the
      discontinuation and
      side effects profiles were comparable to that seen
      normally. The
      authors
      (Diana Sylvestre, abstract 2886) credit their weekly
      education/support
      group
      with maximizing compliance.

      The authors of this abstract used a group support
      technique that
      emphasizes
      peer support and support, education, and maximizes
      medical resource
      utilization. They use weekly groups consistingof 15-30
      individuals in
      varying
      stages of HCV treatment including early diagnosis to
      post treatment
      remission
      or relapse. The sessions combined interactive
      education about HCV &
      treatment, peer directed support and discussions, and
      medical
      intervention.
      The groups are geared to recovering substance abusers.


      Regardless of the particular design or approach, the
      group process is a
      model
      that can work to support adherence & treatment in HIV
      and HCV.
      Abstracts
      reported at the Retrovirus Conference underscored the
      need to continue
      group
      for a long term as short term groups may not
      accomplish the long term
      goals
      of succeeding with therapy.

      Entry criteria for these groups include active HCV
      infection as
      demonstrated
      by positive PCR, liver fibrosis as demonstrated by
      either liver biopsy
      or
      surrogate markers of fibrosis, and stable abstinence
      from illicit drug
      use.

      RESULTS

      29% have cirrhosis. 54% have a psichiatric diagnosis.
      12% use alcohol.
      74%
      are Caucasian, 16% African-American, and 10% are
      Latino. 61% are male.
      And
      the average is 50 yrs. Genotype 1: 60% of Caucasians,
      80% of
      African-Americans and 58% of Latinos.

      Retrospective analysis of the first 61 patients out
      the 160 planned
      patient
      enrollment shows a side-effect profile (flu 64%,
      psychiatric 36%, GI
      32%) and
      dose reduction (20%) equivalent to that of historical
      controls. The
      overall
      dropout rate is 18% (2% for medical reasons; 8% for
      psychiatric; 6% for
      side
      effects; n=30). The preliminary end-of-treatment
      response rate to date
      (n=30)
      is 55%, and authors state this is similar to published
      studies. But, of
      course this is preliminary to judge the outcomes as we
      only have ETR
      data on
      30 of 160 planned patients.

      However, the authors conclude HCV treatment in
      recovering injection
      drug
      users on methadone is safe, tolerable, and
      efficacious. They report
      group
      treatment can maximize the use of medical resources.
      Studies are needed
      in
      treating active injection drug users, particularly
      those using harm
      reduction
      including needle exchange programs.


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    • claudine intexas
      NATAP Reports Highlights from Digestive Disease Week May 20-23, 2001 Atlanta, Georgia Treating Hepatitis C in Recovering Injection Drug Users on Methadone
      Message 2 of 2 , Oct 25, 2001
        NATAP
        Reports Highlights from
        Digestive Disease Week
        May 20-23, 2001
        Atlanta, Georgia

        Treating Hepatitis C in Recovering Injection Drug
        Users on Methadone

        Despite the high prevalence of HCV in recovering
        injection drug users, there is little data on the
        safety, tolerability, and efficacy of combination
        interferon/ribavirin therapy in this group. This study
        presented at DDW (May 2001) reports on the experience
        of treating persons on Methadone Maintenance using an
        educational support model for the patients. The
        authors report that the preliminary viral response
        rates to therapy, and the discontinuation and side
        effects profiles were comparable to that seen
        normally. The authors (Diana Sylvestre, abstract 2886)
        credit their weekly education/support group with
        maximizing compliance.

        The authors of this abstract used a group support
        technique that emphasizes peer support and support,
        education, and maximizes medical resource utilization.
        They use weekly groups consistingof 15-30 individuals
        in varying stages of HCV treatment including early
        diagnosis to post treatment remission or relapse. The
        sessions combined interactive education about HCV &
        treatment, peer directed support and discussions, and
        medical intervention. The groups are geared to
        recovering substance abusers.

        Regardless of the particular design or approach, the
        group process is a model that can work to support
        adherence & treatment in HIV and HCV. Abstracts
        reported at the Retrovirus Conference underscored the
        need to continue group for a long term as short term
        groups may not accomplish the long term goals of
        succeeding with therapy.

        Entry criteria for these groups include active HCV
        infection as demonstrated by positive PCR, liver
        fibrosis as demonstrated by either liver biopsy or
        surrogate markers of fibrosis, and stable abstinence
        from illicit drug use.

        RESULTS

        29% have cirrhosis. 54% have a psichiatric diagnosis.
        12% use alcohol. 74% are Caucasian, 16%
        African-American, and 10% are Latino. 61% are male.
        And the average is 50 yrs. Genotype 1: 60% of
        Caucasians, 80% of African-Americans and 58% of
        Latinos.

        Retrospective analysis of the first 61 patients out
        the 160 planned patient enrollment shows a side-effect
        profile (flu 64%, psychiatric 36%, GI 32%) and dose
        reduction (20%) equivalent to that of historical
        controls. The overall dropout rate is 18% (2% for
        medical reasons; 8% for psychiatric; 6% for side
        effects; n=30). The preliminary end-of-treatment
        response rate to date (n=30) is 55%, and authors state
        this is similar to published studies. But, of course
        this is preliminary to judge the outcomes as we only
        have ETR data on 30 of 160 planned patients.

        However, the authors conclude HCV treatment in
        recovering injection drug users on methadone is safe,
        tolerable, and efficacious. They report group
        treatment can maximize the use of medical resources.
        Studies are needed in treating active injection drug
        users, particularly those using harm reduction
        including needle exchange programs.


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