Year: 2007
Type: article
Abstract: C urrently, the primary risk factor for hepatitis C virus (HCV) is injection drug use; it is estimated that 80% to 95% of intravenous drug users (IDUs) are infected or will become infected with HCV in the near future (1).This marginalized group in our society is well recognized to be at risk for alcoholism, psychiatric illness and psychosocial instability (2,3), and historically, they have not been considered viable candidates for HCV treatment.In this issue of The Canadian Journal of Gastroenterology, Moirand et al (pages 355-361), in their paper titled "Determinants of antiviral treatment initiation in a hepatitis C-infected population benefiting from universal health care coverage", retrospectively reviewed HCV treatment and the determinants of antiviral treatment initiation in a vulnerable, urban, inner-city population.The authors evaluated the chart documentation of 3300 patients and identified 378 patients eligible for HCV antiviral therapy.Of the 378 eligible patients, 143 were offered and initiated treatment, while 95 were offered but rejected treatment.Variables that influenced treatment included a resolute request for treatment, participation in methadone maintenance therapy, younger age and past alcohol use.Factors that negatively influenced treatment included current intravenous drug use, alcoholic liver damage on biopsy, precarious or unspecified housing, current depression and personality disorders.An important observation to note from the paper by Moirand et al is that of the patients considered medically eligible for treatment, only 63% were offered therapy, and of these, only 60% accepted (ie, less than 40% of the medically eligible cohort).This suggests that potentially viable patient populations may not be receiving treatment.The work of Moirand et al is consistent with other studies that reported successful treatment of IDUs provided that they were closely supervised.Backmund et al (4) reported on the treatment of 50 IDUs with interferon or interferon and ribavirin combination therapy.The rate of sustained virological response (SVR) was 36% and was not significantly different between those patients who relapsed to drug use and those who did not.Van Thiel et al (1) also demonstrated that the SVR in IDUs was similar to that in non-IDUs.They also reported that the recent use of intravenous drugs or continued methadone use during treatment did not impair the SVR in comparison with non-IDUs.Unfortunately, in today's world, the number of treated HCV patients needs to increase dramatically or we will not be able to prevent new infections or reduce the burden of end-stage liver disease.Clearly, we can no longer ignore vulnerable populations, and effective interventions must be
DOI: 10.1155/2007/652365
Authors: Jo-Ann Ford, Cindy Cheong-Lee
Language: English
Topic: Hepatitis C virus research
Subfield: Hepatology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,100
OpenAlex ID: W2292853066