Injection drug users are often denied Hepatitis C treatment due to concerns about adherence.
This occurs despite limited data about the impact of such common issues as psychiatric illness and intercurrent drug use.
Dr Diana Sylvestre and colleagues defined the impact of these and other potential adherence barriers in a real-world sample of recovering drug users.
The team conducted a prospective observational study of 71 methadone-maintained patients.
The patients who received interferon and ribavirin combination therapy in a community-based clinic with expertise in treating addictive disorders.
Adherence measures were conducted with monthly interview, medication counts, and urine toxicology testing.
|The researchers found that 68% were adherent|
|European Journal of Gastroenterology & Hepatology|
The researchers found that 68% were adherent.
The team noted that adherent patients were significantly more likely to achieve a sustained virologic response, occurring in 42% vs 4% in nonadherent patients.
Patients with and without a prior psychiatric history were similarly adherent.
The researchers observed that the initiation of new psychiatric medications during Hepatitis C treatment was associated with improved adherence overall.
The team found that initiation of psychiatric medications during Hepatitis C treatment was also associated with improved adherence in those without a preexisting psychiatric diagnosis.
Trends toward reduced adherence in patients without a period of abstinence was seen before initiating Hepatitis C treatment, and in those abstinent for at least 1 month.
The team noted that occasional drug users were similarly adherent to those who were completely abstinent.
Patients who relapsed to regular drug use showed a significantly lower level of adherence.
Dr Sylvestre‘s team concludes, "The majority of methadone-maintained drug users can adhere to Hepatitis C treatment, even those with psychiatric illness and relatively limited pretreatment drug abstinence.
"Lack of pre-Hepatitis C treatment drug abstinence and regular drug use during Hepatitis C treatment may be relative barriers to medication adherence, but the initiation of psychiatric medications during Hepatitis C treatment may be a helpful intervention."
"This report provides further evidence for an individualized approach to Hepatitis C treatment that does not categorically exclude patients with potential barriers such as mental illness and limited drug abstinence."