Treating Hepatitis C in Methadone Patients: With Planning, it Works! Patricia Perkins, MS, MPH Independent Healthcare Consultant Community Advisory Board Member Organization to Achieve Solutions in Substance- Abuse (O.A.S.I.S.)

IFN alfa-2b/RBV: Summary of Predictive Factors for a SVR Weight > 75 kg Weight  75 kg High Fibrosis Low Fibrosis Male Female Age > 40 Age  40 High HCV RNA Low HCV RNA Genotype 1 Genotype 2 or 3 Increasing usefulness in predicting sustained response % Sustained Virologic Response McHutchison JG et al. Semin Liver Dis. 1999;19(suppl 1):63.

Questions: some of the many… Does methadone use affect HCV treatment: dosing levels? Does psychiatric disease in IDUs affect HCV treatment? Should all patients be on SSRI’s? Does length of sobriety affect HCV treatment? Does alcohol use [during tx] affect HCV treatment? Does illicit drug use [during tx] affect HCV treatment?

O.A.S.I.S., Oakland, CA Medical Care FOR IDUs Addresses special needs of IDU – Distrust of authority – High prevalence of psychiatric illness – Psychosocial problems – Limited or Inconsistent Social Support – High level of misinformation about HCV and most other medical illnesses

Group Treatment Model: One Stop Shopping Education Peer support Medical monitoring

O.A.S.I.S. HCV Patients >900 patients screened to date: from 5-8 area MMTs and other persons with DU histories – All with Liver Function Tests – Most with PCR (polymerase chain reaction) and/or genotype >100 treated

O.A.S.I.S. HCV Patient Demographics 51% male vs 66% 47 yr vs 42 yr 58% Caucasian vs 95% 29 yr infected vs 17 yr 61% psychiatric dx 29% cirrhosis vs 4%

Histology in Treated MMT

ALT vs Liver Fibrosis

Interim Interferon/Ribavirin Treatment Results n=67 n=59

OASIS non-MMT vs OASIS MMT n=67 n=17n=59 n=22

The Impact of Psychiatric Disease in MMT p=0.46 n=22 n=41 n=37 n=26

The Impact of Alcohol Use on HCV Treatment p=0.46 n=57 n=45 n=12 n=47 n=13 n=45 n=12

Impact of Drug Use During HCV Treatment n=57 n=6 n=37 n=17n=4 n=57 n=17 n=40 n=20 n=39 n=37 n=20

Impact of Illicit Drug Quantity on HCV Outcomes n=57 n=6 n=37 n=17n=4 n=7 n=40 n=6 n=4 n=7 n=39 n=7 n=5 n=7 n=37 n=7 n=5 n=7

Impact of Pretreatment Drug Sobriety n=11 n=9 n=12 n=25 n=39 n=9 n=12 n=37 n=8 n=12

Treatment Results: No Preexisting Psych, No Drugs, No Alcohol n=13 n=12

Early Conclusions: HCV treatment in MMT is safe, tolerable, and efficacious. Psychiatric illness, intermittent drug use, and alcohol use have a modest negative impact on treatment outcomes in MMT. Regular drug use may impact substantially on virologic outcomes, and therefore relapse to drug use during HCV treatment should lead to aggressive substance abuse intervention.

Acknowledgements O.A.S.I.S. staff, Board, CAB & volunteers ***Schering Oncology-Biotech Participating MMT clinics – BAART – SAACS – 14 th St. Clinic – HAART

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