Gastroenterology
Volume 138, Issue 1 , Pages 123-135.e2, January 2010

Effective Treatment of Injecting Drug Users With Recently Acquired Hepatitis C Virus Infection

  • Gregory J. Dore

      Affiliations

    • National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia
    • HIV/Immunology/Infectious Diseases Clinical Services Unit, St Vincent's Hospital, Sydney, Australia
    • Corresponding Author InformationReprint requests Address requests for reprints to: Professor Gregory J. Dore, National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Level 2, 376 Victoria Street, Darlinghurst, New South Wales, 2010 Australia. fax: (61) 2-9385-0876
    • ,
  • Margaret Hellard

      Affiliations

    • Burnet Institute, Melbourne, Australia
    • Infectious Diseases Unit, The Alfred Hospital, Melbourne, Australia
    • ,
  • Gail V. Matthews

      Affiliations

    • National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia
    • HIV/Immunology/Infectious Diseases Clinical Services Unit, St Vincent's Hospital, Sydney, Australia
    • ,
  • Jason Grebely

      Affiliations

    • National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia
    • ,
  • Paul S. Haber

      Affiliations

    • Drug Health Services, Royal Prince Alfred Hospital, Sydney, Australia
    • Central Clinical School, University of Sydney, Sydney, Australia
    • ,
  • Kathy Petoumenos

      Affiliations

    • National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia
    • ,
  • Barbara Yeung

      Affiliations

    • National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia
    • ,
  • Philippa Marks

      Affiliations

    • National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia
    • ,
  • Ingrid van Beek

      Affiliations

    • Kirketon Road Centre, Sydney, Australia
    • ,
  • Geoffrey McCaughan

      Affiliations

    • Central Clinical School, University of Sydney, Sydney, Australia
    • Royal Prince Alfred Hospital, Sydney, Australia
    • ,
  • Peter White

      Affiliations

    • School of Medical Sciences, University of New South Wales, Sydney, Australia
    • ,
  • Rosemary French

      Affiliations

    • Burnet Institute, Melbourne, Australia
    • ,
  • William Rawlinson

      Affiliations

    • School of Medical Sciences, University of New South Wales, Sydney, Australia
    • Virology Division, SEALS Microbiology, Prince of Wales Hospital, Sydney, Australia
    • ,
  • Andrew R. Lloyd

      Affiliations

    • School of Medical Sciences, University of New South Wales, Sydney, Australia
    • ,
  • John M. Kaldor

      Affiliations

    • National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia
    • ,
  • Australian Trial In Acute Hepatitis C Study Group

Received 18 June 2009; accepted 15 September 2009. published online 25 September 2009.

Background & Aims

Patients with acute hepatitis C virus (HCV) infection who receive treatment achieve high rates of sustained virologic response (SVR), but few studies have examined outcomes among injecting drug users (IDUs). We evaluated the efficacy of treatment of recent HCV infection in IDUs with acute and early chronic HCV.

Methods

We analyzed data from the Australian Trial in Acute Hepatitis C—a prospective study of the natural history and treatment outcomes of patients with recent HCV infection. Participants eligible for the study had their first anti-HCV antibody–positive test result within the past 6 months and either acute clinical HCV within the past 12 months or documented anti-HCV seroconversion within 24 months. Participants with HCV received pegylated interferon–alfa-2a (180 μg/wk, n = 74); those with HCV/human immunodeficiency virus (HIV) co-infection received pegylated interferon–alfa-2a (180 μg/wk) with ribavirin (n = 35) for 24 weeks.

Results

From June 2004 to February 2008, 167 participants were enrolled in the Australian Trial in Acute Hepatitis C; 79% had injected drugs in the previous 6 months. Among 74 with only HCV, the SVRs were 55% and 72% by intention-to-treat and per-protocol analysis, respectively. In multivariate analyses, baseline factors independently associated with lower SVR included decreased social functioning and current opiate pharmacotherapy. Adherent participants had higher SVR rates (63% vs 29%; P = .025). Of the 35 participants with HCV/HIV co-infection, the SVRs were 74% and 75% by intention-to-treat and per-protocol analysis, respectively.

Conclusions

Treatment of recent HCV infection among IDUs, including those with HIV co-infection, is effective. Strategies to engage socially marginalized individuals and increase adherence should improve treatment outcomes in this population.

Abbreviations used in this paper: ATAHC, Australian Trial in Acute Hepatitis C, HIV, human immunodeficiency virus, IDU, injection drug user, SVR, sustained virologic response

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 Conflicts of interest These authors disclose the following: Gregory Dore, G.M., and J. Kaldor have received research support from Roche Pharmaceuticals; Gregory Dore is on the speaker's bureau for Roche Pharmaceuticals; Gregory Dore and G.M. are members of the advisory board for Roche Pharmaceuticals; Gregory Dore, P. Marks, and B. Yeung have received travel grants from Roche Pharmaceuticals; Gregory Dore is a consultant/advisor for Schering Plough, Tibotec, and Abbott; and G.M. is a consultant/advisor for Schering Plough, Novartis, and Astellar. The remaining authors disclose no conflicts.

 Funding This study was funded by the National Institutes of Health (grant RO1 DA 15999-01). The National Centre in HIV Epidemiology and Clinical Research is funded by the Australian Government Department of Health and Ageing and is affiliated with the Faculty of Medicine, University of New South Wales. Roche Pharmaceuticals supplied financial support for pegylated IFN alfa-2a/ribavirin. Gregory Dore, P. Haber, and A. Lloyd were supported by National Health and Medical Research Council Practitioner Research Fellowships; M. Hellard was supported by a National Health and Medical Research Council Career Development Award and a VicHealth Senior Research Fellowship; J. Grebely was supported by Postdoctoral fellowships from the Canadian Institutes of Health Research and the National Canadian Research Training Program in Hepatitis C; R. French was supported by a National Health and Medical Research Council Industry fellowship; and J. Kaldor was supported by National Health and Medical Research Council Research Fellowship.

PII: S0016-5085(09)01660-6

doi:10.1053/j.gastro.2009.09.019

Gastroenterology
Volume 138, Issue 1 , Pages 123-135.e2, January 2010

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