Treatment of hepatitis C infection in injection drug users

Chronic hepatitis C is the most common infectious disease among injection d rug users (IDUs). Because of the allegedly poor compliance of IDUs with tre atment requirements and conditions, hepatologists recommend treatment only if former IDUs have spent 6 to 12 months drug free. The aim of this prospec tive study was to investigate whether opiate-dependent IDUs with chronic he patitis C virus (HCV) infection can be treated successfully with interferon . Eligibility for the study meant IDUs had to be HCV-RNA positive by polyme rase chain reaction. Subsequently 50 inpatients were enrolled during detoxi fication treatment. HCV treatment was started with interferon alfa-2a (thro ugh 1998) or a combined regimen consisting of interferon alfa-2a and ribavi rin (begun in 1998). All patients were treated and supervised by specialize d physicians in both hepatology and addiction medicine. The end point for t his study was defined as a loss of detectable serum HCV RNA at week 24 afte r treatment. The rate of sustained virologic response was 36%. Sustained re sponse rates were not significantly different for patients who relapsed and returned to treatment (53%), relapsed and did not return to treatment (24% ), or did not relapse (40%; P > .05). During the 24 weeks after treatment, we were unable to detect any reinfection, even among patients who injected heroin during this period. This surprising result should be examined in fur ther studies. In conclusion, HCV-infected drug addicts with chronic HCV inf ection can be treated successfully with interferon alfa-2a and ribavirin if they are closely supervised by physicians specialized in both hepatology a nd addiction medicine.