Community-Based Treatment for Chronic Hepatitis C in Drug Users: High Rates of Compliance With Therapy Despite Ongoing Drug Use

The authors note that UK authorities' hepatitis C virus (HCV) treatment guidelines are evolving with respect to injecting drug users (IDUs). Nonetheless, patients with circumstances thought to reduce compliance are excluded from many studies, limiting the assessment of socially challenged IDUs and of who would most likely benefit from antiviral therapy. The current study examines factors influencing chronic HCV infection treatment compliance among IDUs.

The investigators established a community-based treatment program at the East London Specialist Addiction Unit and offered antiviral therapy for all HCV-positive IDUs who expressed an interest. During a two-year period ending March 2007, 83 of 441 HCV-positive addiction patients chose to attend an outreach liver clinic for consideration of antiviral therapy. Fourteen subsequently declined treatment, and six were medically precluded from it. Sixty-three patients agreed to therapy, 58 completed it, and two were re-treated during the assessment, for 60 completed treatment episodes. Among these episodes of completed treatment, compliance was greater than 80 percent. Homelessness, continued illicit drug use, and pre-treatment antidepressant therapy were not associated with non-adherence. In 25 of 49 (51 percent) treatment episodes assessed at six months after treatment cessation, a sustained virological response was seen.

"We find that 'unstable,' homeless, active injectors with multiple adverse social factors can be successfully treated," concluded the authors.

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