Patients receiving opioid maintenance treatment in primary care: successful chronic hepatitis C care in a real world setting

• Main Authors: Seidenberg André, Rosemann Thomas, Senn Oliver
• Format: Article
• Language: English
• Published: BMC 2013-01-01
• Series: BMC Infectious Diseases
• Subjects: Hepatitis C; Methadone substitution; Primary care
• Online Access: http://www.biomedcentral.com/1471-2334/13/9

<p>Abstract</p> <p>Background</p> <p>Injection drug users (IDUs) represent a significant proportion of patients with chronic hepatitis C (CHC). The low treatment uptake among these patients results in a low treatment effectiveness and a limited public health impact. We hypothesised that a general practitioner (GP) providing an opioid maintenance treatment (OMT) for addicted patients can achieve CHC treatment and sustained virological response rates (SVR) comparable to patients without drug dependency.</p> <p>Methods</p> <p>Retrospective patient record analysis of 85 CHC patients who received OMT for more than 3 months in a single-handed general practice in Zurich from January 1, 2002 through May 31, 2008. CHC treatment was based on a combination with pegylated interferon and ribavirin. Treatment uptake and SVR (undetectable HCV RNA 6 months after end of treatment) were assessed. The association between treatment uptake and patient characteristics was investigated by multiple logistic regression.</p> <p>Results</p> <p>In 35 out of 85 CHC patients (52 males) with a median (IQR) age of 38.8 (35.0-44.4) years, antiviral therapy was started (41.2%). Median duration (IQR) of OMT in the treatment group was 55.0 (35.0-110.1) months compared to the group without therapy 24.0 (9.8-46.3) months (p<0.001). OMT duration remained a significant determinant for treatment uptake when controlled for potential confounding. SVR was achieved in 25 out of 35 patients (71%).</p> <p>Conclusion</p> <p>In addicted patients a high CHC treatment and viral eradication rate in a primary care setting in Switzerland is feasible. Opioid substitution seems a beneficial framework for CHC care in this “difficult to treat” population.</p>