Eligibility for Hepatitis C Treatment and Outcomes among U.S. Veterans: Role of Injection Drug Use

Many patients with a history of injection drug use have been excluded from treatment for chronic hepatitis C virus (HCV) infection due to the belief that they are poor candidates and unlikely to adhere well to therapy.

As reported in the February 2007 Journal of Clinical Gastroenterology, researchers at various Department of Veterans Affairs (VA) medical centers conducted a study to determine the impact of injection drug use history on HCV treatment candidacy and outcomes.

Between 1999 and 2001, a total of 4318 HCV-infected patients seen at 24 VA medical centers were evaluated for HCV treatment candidacy and followed prospectively. Univariate and multivariate logistic regression analyses were performed to assess whether history of drug injection was associated with HCV treatment candidacy, acceptance of treatment, early treatment discontinuation, and virological response.

Results

• Of 4318 participants, 2611 (61%) reported a history of injection drug use.

• Injection drug use history was not significantly associated with HCV treatment candidacy, acceptance, early discontinuation of therapy, or virological response (all P values non-significant).

• Patients not considered candidates for HCV treatment candidacy were more likely to:

- have low incomes (OR 1.46.74);
- have 12 or fewer years of education (OR 1.23);
- consume 3 or more alcoholic drinks per day (OR 2.08).

• Early discontinuation of HCV therapy was independently associated with low income and consumption of 3 or more drinks per day.

Conclusion

In conclusion the authors wrote, "A history of injection drug use was not associated with HCV treatment candidacy or outcomes, supporting national guidelines to evaluate former injection drug users on a case-by-case basis for HCV treatment."

VA Medical Center and the University of California at San Francisco, San Francisco, CA; VA Medical Center, Houston, TX; VA New York Harbor Healthcare System and NYU School of Medicine, New York, NY; VA Medical Center, Bronx, NY; VA Medical Center, Miami, FL.

02/13/07

Reference
K H Seal, S L Currie, H Shen, and others. Hepatitis C Treatment Candidacy and Outcomes Among 4318 US Veterans with Chronic Hepatitis C Virus Infection: Does a History of Injection Drug Use Matter? Journal of Clinical Gastroenterology 41(2): 199-205. February 2007.