Are treatments for HCV effective in MMT patients?

 Up to 9 of every 10 injection drug users entering MMT programs may be infected with hepatitis C (HCV), so this is an important question. It is especially critical since MMT patients face many barriers to liver transplantation, which may be necessary for survival if HCV treatment is denied or ineffective.

This topic was previously discussed from an evidence-based perspective in a series of AT Forum articles during 2001-2002.[1] The bottom-line answer is that HCV treatments continue to improve and MMT patients can respond as well as any other persons.

Approximately 170 million people world-wide are chronically infected with the hepatitis C virus (HCV). While the seroprevalence in the general population ranges between 0.2 and 2%, 50-90% of injection drug users are chronically HCV-infected. However, many patients who are in methadone maintenance treatment are still excluded from therapy for HCV infection.

The authors of one review article examined clinical trials published between 1987 and 2003 that focused on the treatment of chronic HCV in patients with drug addiction or in methadone maintenance treatment.[2] They found only seven clinical trials investigating HCV treatment among current or former drug abusers.

The studies indicated that successful response to anti-HCV treatment and adherence to the treatment regimen in infected methadone patients were comparable to any other patients in the general population. However, MMT patients with persistent drug abuse seemed more likely to discontinue treatment early.

A clinical trial reported in 2004 noted that, compared with general population subjects, MMT patients had a comparable sustained viral response (SVR) to anti-HCV treatment with peginterferon alfa-2b and ribavirin.[3] Pegylated interferon (or peginterferon) is a newer, longer-acting version of interferon. SVR denotes the absence of virus 6 months after treatment, which some describe as a “cure.” In this study, more MMT patients had difficulties with compliance or requested discontinuation of treatment only during the first 2 months.

Of further interest, the latest research has reported that the peginterferon-ribavirin combination also is quite effective in patients co-infected with HCV and HIV (the virus causing AIDS).[4,5] This could be important for many MMT patients; although, the studies did not specifically include any methadone-maintained subjects.

Sources:

 Schaefer M, et al. Treatment of chronic hepatitis C in patients with drug dependence: time to change the rules? Addiction. 2004;99(9):1167-1175.

. Mauss S, Berger F, Goelz J, Jacob B, Schmutz G. A prospective controlled study of interferon-based therapy of chronic hepatitis C in patients on methadone maintenance. Hepatology. 2004;40(1):120-124.