Naslov
Intravenous Drug Users Can Achieve a High Sustained Virological Response Rate : Experience From Croatian Reference Center for Viral Hepatitis

Autori
Kurelac, Ivan ; Papić, Neven ; Sakoman, Slavko ; Orban, Mirjana ; Dušek, Davorka ; Ćorić, Marijana ; Vince, Adriana

Izvornik
Hepatitis Monthly (1735-143X) 11 (2011), 12; 986-992

Vrsta, podvrsta i kategorija rada
Radovi u časopisima, članak, znanstveni

Ključne riječi
addiction; intravenous drug users; viral hepatitis; chronic hepatitis C; antiviral therapy

Sažetak
Hepatitis C virus (HCV) is the major infectious disease agent among injecting drug users (IVDUs). However, most of the IVDUs are still excluded from the treatment. The aim of this study was to examine the treatment course, adherence, tolerability and safety profiles and SVR rates in IVDUs compared to non-IVDUs. Demographic and clinical data were collected from medical records of 345 adult patients diagnosed with chronic hepatitis C (CHC) who were treated with a PEG-IFN-α and ribavirin in Croatian Reference Center for Viral Hepatitis in Zagreb in period between January 2003 and January 2010. Efficacy, safety and tolerability treatment profiles were analyzed in IVDUs versus non IVDUs. Positive predictors for treatment outcome were evaluated by univariate and multivariate logistic regression. A total of 106 (30.46%) IVDUs were recognized. The IVDUs were characterized by predominated male sex (81.13% vs. 52.30%, p=0.0001), younger age (32.46±5.33y vs. 46.12±11.48y, p=0.0001), lower fibrosis and HAI score (measured by ISHAK) and shorter duration of infection (8.98±5.87 vs. 16.79±8.99y, p=0.0001) than non-IVDU group. In IVDUs genotype 1a (24.52%) and 3a (38.68%) were predominant. There were no differences in completion rate between two groups. IVDUs achieved significantly higher rates of overall SVR (70.75 vs 51.04, p<0.0009) and in genotypes 1 and 4 (65.08% vs. 48.73%, p=0.0294) versus non-IVDUs. Treatment discontinuation rates due to side-effects were not significantly different in IVDUs and non IVDUs (2.83% vs. 7.11%, p=0.1390). IVDU group had higher rate of lost to follow up (13.21% vs. 4.60%, p=0.0071). There were no statistical differences in SVR rate between IVDUs with, or without substitution therapy (55.55 vs. 74.62%, p=0.0866). Independent predictors of SVR were age < 40 years and genotypes 2 and 3. Type of PEG-IFN-α was not associated with SVR. Treatment of CHC in IVDUs should strongly be encouraged as they have positive predictors for achieving SVR such as younger age, shorter duration of infection, consequently favorable histological stage of the disease, and good adherence to treatment. There is no difference in safety and tolerability profile of treatment in IVDUs compared to patients with no history of drug abuse.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti, Javno zdravstvo i zdravstvena zaštita, Psihologija

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