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Treating Hepatitis C in Methadone Patients: With Planning, it Works!

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.) www.oasisclinic.org.

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Treating Hepatitis C in Methadone Patients: With Planning, it Works!

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  1. 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.) www.oasisclinic.org

  2. IFN alfa-2b/RBV: Summary of Predictive Factors for a SVR Genotype 2 or 3 Genotype 1 Low Fibrosis High Fibrosis Low HCV RNA High HCV RNA Age £ 40 Age > 40 Female Increasing usefulnessin predictingsustained response Male Weight £ 75 kg Weight > 75 kg 20 40 60 80 % Sustained Virologic Response McHutchison JG et al. Semin Liver Dis. 1999;19(suppl 1):63.

  3. 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?

  4. 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

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

  6. 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

  7. 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%

  8. Histology in Treated MMT

  9. ALT vs Liver Fibrosis

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

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

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

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

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

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

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

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

  18. 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.

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

  20. Knowledge is power. Saber es el poder. Please Join our Fight! Future Presentations will continue to be posted on our website: http://www.oasisclinic.org

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