Patients receiving opioid maintenance treatment in primary care: successful chronic hepatitis C care in a real world setting

BMC Infect Dis. 2013 Jan 8;13:9. doi: 10.1186/1471-2334-13-9.

Abstract

Background: Injection drug users (IDUs) represent a significant proportion of patients with chronic hepatitis C (CHC). The low treatment uptake among these patients results in a low treatment effectiveness and a limited public health impact. We hypothesised that a general practitioner (GP) providing an opioid maintenance treatment (OMT) for addicted patients can achieve CHC treatment and sustained virological response rates (SVR) comparable to patients without drug dependency.

Methods: Retrospective patient record analysis of 85 CHC patients who received OMT for more than 3 months in a single-handed general practice in Zurich from January 1, 2002 through May 31, 2008. CHC treatment was based on a combination with pegylated interferon and ribavirin. Treatment uptake and SVR (undetectable HCV RNA 6 months after end of treatment) were assessed. The association between treatment uptake and patient characteristics was investigated by multiple logistic regression.

Results: In 35 out of 85 CHC patients (52 males) with a median (IQR) age of 38.8 (35.0-44.4) years, antiviral therapy was started (41.2%). Median duration (IQR) of OMT in the treatment group was 55.0 (35.0-110.1) months compared to the group without therapy 24.0 (9.8-46.3) months (p<0.001). OMT duration remained a significant determinant for treatment uptake when controlled for potential confounding. SVR was achieved in 25 out of 35 patients (71%).

Conclusion: In addicted patients a high CHC treatment and viral eradication rate in a primary care setting in Switzerland is feasible. Opioid substitution seems a beneficial framework for CHC care in this "difficult to treat" population.

MeSH terms

  • Adult
  • Analgesics, Opioid / administration & dosage
  • Analgesics, Opioid / therapeutic use*
  • Antiviral Agents / administration & dosage
  • Antiviral Agents / therapeutic use
  • Female
  • Genotype
  • Hepacivirus / genetics
  • Hepatitis C, Chronic / drug therapy
  • Hepatitis C, Chronic / etiology*
  • Hepatitis C, Chronic / virology*
  • Humans
  • Male
  • Middle Aged
  • Substance-Related Disorders / complications*
  • Substance-Related Disorders / drug therapy*
  • Treatment Outcome
  • Viral Load

Substances

  • Analgesics, Opioid
  • Antiviral Agents