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Author List:
Seal KH (San Francisco VAMC)
Currie SL (San Francisco VAMC)
Anand B (Houston VAMC)
Jeffers L (Miami VAMC)
Wright TL
For the VA-HCV-001 group
Objectives:
This study sought to determine the impact of injection drug use (IDU) on hepatitis C (HCV) treatment candidacy and outcomes among veterans with chronic HCV infection.
Methods:
At 25 VA medical centers, between 1999-2001, 4,462 anti-HCV (+) veterans were evaluated for HCV treatment candidacy and followed prospectively. Veterans were included in this study if they had detectable HCV RNA virus by polymerase chain reaction, had not been previously treated for HCV, and responded to questions about IDU behavior. Participants were categorized into three groups: 1) no history of IDU (no IDU), 2) IDU prior to 1990 (distant IDU), and 3) IDU from 1991 to the present (recent IDU). Treatment candidacy was determined by experienced clinicians based on existing VA HCV treatment guidelines. Among participants accepting treatment, interferon alfa-2b 3MU three times weekly + ribavirin for 24 weeks (genotypes-2/3) or 48 weeks (genotypes-1) was administered. End-of-treatment response (ETR) and sustained virological response (SVR), defined as having undetectable HCV RNA at end of treatment and 6 months later, were measured. Between-group comparisons were assessed in an intention-to-treat analysis using chi-squared tests.
Results:
Of 4,414 veterans included in this study, 1,055 (24%) were considered eligible HCV treatment candidates. IDU ever in the past was reported by 2,650 (60%) and of these, 2,006 (76%) reported distant IDU and 576 (22%) reported recent IDU. Among 1,055 eligible HCV treatment candidates, 40% reported no IDU, 48% distant IDU, and 12% recent IDU (p=0.08). Of these, 782 (74%) initiated HCV treatment. Treatment was discontinued early by 235 (30%), yet there were no significant differences among the three groups (p=0.77). An ETR was achieved by 232 (30%), while 143 (18%) achieved SVR. No significant differences were found among the three groups for ETR (p=0.55) and SVR (p=0.41).
Implications:
A substantial proportion reported IDU in the last decade and while not statistically significant, fewer of these veterans were considered eligible treatment candidates. Of note, among those initiating HCV treatment, no significant differences were found in early treatment discontinuation, ETR or SVR.
Impacts:
This study provides evidence for the revised VA HCV treatment guidelines (2002) advocating HCV treatment for veterans with a history of IDU.
