Treatment of Hepatitis C within a Methadone Maintenance Program Yields Results Comparable to Treatment via Other Models of Care

Hepatitis C virus (HCV) affects more than 4 million people in the US, 60% of whom have a history of injection drug use (IDU). Concerns over treatment adherence, psychiatric comorbidity, ongoing drug use, and optimal timing of HCV treatment initiation have resulted in unwillingness on the part of many physicians to treat HCV in patients with IDU.

This retrospective study investigated outcomes in patients with co-occurring HCV infection and opioid dependence (N=73) treated for HCV within an ongoing methadone maintenance program. At treatment initiation, 49% of patients had continuing drug use, 67% had psychiatric comorbidity, and 32% had HIV co-infection. Treatment for HCV was delivered by internists via standardized protocol with pegylated interferon and ribavirin. Main outcome measures were undetectable viral load at the end of treatment and at 6 months following treatment completion.

• Eighty-six percent of patients completed at least 12 weeks of HCV treatment.
• Fifty-five percent of patients had an undetectable viral load at the end of treatment, and 45% had an undetectable viral load 6 months post-treatment.
• Thirty percent of patients continued to use illicit substances during treatment, and 23% received a methadone dose increase.

Comments by James Harrison, MHS, CADC
Unwillingness to treat co-occurring HCV in people with IDU is inappropriate in some cases. Hepatitis C and addiction are both treatable diseases, and the sustained viral response among methadone patients treated for HCV in this study clearly demonstrates that treatment can work. These results provide compelling evidence that patients with opioid dependence should be treated with the same respect and breadth of care as non-IDU patients.