Methadone Programs May Play Key Role in Helping Hepatitis C Patients

“These new findings support the premise that addiction-treatment facilities can help provide sustained HCV treatment for this population,” says Talal, senior author.

“These facilities have the added advantage of being able to link HCV care to drug treatment, allowing for closer patient evaluation, which will likely lead to improved adherence to treatment regimens.”

“One of the most important findings of this work is that people who inject drugs want to be educated about HCV, and that education is associated with their willingness to be treated,” says Talal, professor of medicine in the Division of Gastroenterology, Hepatology and Nutrition.

This represents “a major change in the attitudes of people who use drugs,” Talal notes. He attributes the shift to patient knowledge about greatly improved treatment efficacy and the ability to provide HCV treatment at the same site as substance abuse treatment.

More effective medications for HCV infection — with fewer side effects — also are contributing to a shift in patients’ attitudes, he says.

In addition, increased diagnoses, due to a New York State law that requires health care providers to offer HCV screening to those born between 1945 and 1965, is making people more receptive to HCV education and treatment, Talal notes.

Patients facing both substance abuse and HCV fare better when they are treated for both conditions.

Talal and his colleagues previously demonstrated that treatment for addiction significantly enhances drug users’ ability to complete HCV therapy.

“People who inject drugs have always wanted to be treated for hepatitis C, but there have been a variety of barriers at the patient, provider and institutional levels,” says Talal. 

Barriers have included a lack of education about the disease, discomfort with conventional health care venues and a lack of awareness of the status of the infection, he explains.

Fear of side effects from interferon — part of the standard treatment regimen for HCV infection — has been another key barrier.

Interferon can cause fatigue, fever, nausea, anorexia, muscle pain, hair loss, insomnia, depression, irritability and other side effects. In addition, the combination of interferon and ribavirin is effective in eliminating infection in only half of those who take it.

Talal notes, however, that combining the long-acting form of interferon with ribavirin and direct-acting antivirals is more effective at eliminating the virus. Moreover, the second generation of direct-acting antiviral medications is more effective at virus elimination than the first generation, Talal explains.

By the end of 2014, these medications will be approved for combined use without the need for interferon. “This is a tremendous breakthrough,” he says.

Talal’s study is based on a survey of 320 patients in START Treatment & Recovery Centers, a New York City-based methadone treatment program. 

Nearly half of the patients reported that they had tested positive for HCV infection.

Seventy-eight percent of respondents expressed willingness to participate in HCV-related education and to receive treatment for HCV. More than half of those surveyed correctly answered at least five of seven questions assessing their knowledge of HCV.

The paper notes that injection drug use is a primary mode of infection, leading to an HCV infection prevalence as high as 80 percent among those who inject drugs — especially people over 50. The prevalence among younger injectors is lower due to safer injection practices. 

HCV infection often is asymptomatic, but 75 to 80 percent of those infected will develop chronic infection that can progress to liver cirrhosis and liver cancer, potentially requiring liver transplantation as a life-saving intervention. To be considered for a liver transplant, however, people who have used drugs must remain “clean” for at least six months.

The study, Hepatitis C Virus-Related Knowledge and Willingness to Receive Treatment Among Patients on Methadone Maintenance, has been published in the Journal of Addiction Medicine.

Co-authors with Talal are:

• first author Marija Zeremski, PhD, research assistant professor of medicine
• Rositsa B. Dimova, PhD, research assistant professor of medicine and biostatistics
• researchers from START Treatment & Recovery Centers
• researchers from the Centers for Disease Control and Prevention (CDC)

The study, funded by the Viral Hepatitis Action Coalition and performed in collaboration with the CDC, documents the initial phase of the project “Prevention, Evaluation and Treatment of Hepatitis C in Opiate Agonist Treatment.”

Led by Talal, the project’s goal is to assess how telemedicine can be used to evaluate a model of HCV treatment for people who inject drugs and are enrolled in a drug treatment program.

Abbott Molecular, Abbvie, Gilead Sciences and Vertex Pharmaceuticals also helped sponsor the study.