Opiate users on methadone maintenance therapy can be successfully treated for chronic hepatitis C and can achieve outcomes similar to those of people not on methadone, according to data presented at the 13th European AIDS Conference in Belgrade.
Shared use of injection drug equipment is a major risk factor for both HIV and hepatitis C virus (HCV) infection; an estimated 30% of people with HIV also have hepatitis C. But some clinicians have been reluctant to treat active or former drug users for hepatitis C, largely due to concern about suboptimal adherence and poor outcomes.
Karin Neukam from Hospital Universitario de Valme in Seville, Spain, and colleagues compared treatment response amongst 214 hepatitis C patients – a majority of them injection drug users – who started treatment with pegylated interferon plus ribavirin between January 2003 and May 2010. Just over one-third of participants (38%) were on methadone maintenance while 62% were not.
Most participants were men (88% in the methadone group, 77% in the non-methadone group) and the average age was about 42 years. About 25% in both arms were HIV-positive. Methadone recipients were slightly less likely to have the favorable IL28B “CC” gene pattern and more likely to have liver cirrhosis, but were significantly less likely to have hard-to-treat hepatitis C genotypes 1 or 4.
Almost all participants in both study groups reported 80% or better adherence to hepatitis C therapy. Rates of sustained virological response (SVR) – or continued undetectable HCV viral load 24 weeks after completion of treatment – were similar in the methadone and non-methadone groups.
“The efficacy of HCV therapy in methadone maintenance therapy patients is similar to that found in subjects not taking methadone,” the researchers concluded. “Methadone maintenance therapy patients should be equally considered for treatment with pegylated interferon plus ribavirin.”
These findings indicate that methadone maintenance should not be considered a contraindication to hepatitis C treatment.
Original Source: Neukam K et al. Methadone maintenance therapy does not influence on the outcome of chronic hepatitis C treatment with pegylated interferon and ribavirin. 13th European AIDS Conference, PS7/5, Belgrade, 2011.
Source: NAM AidsMap – October 18, 2011