A French prospective observational study of the treatment of chronic hepatitis C in drug abusers

The objective of this prospective, multicenter, observational study was to evaluate healthcare for hepatitis C virus (HCV)-infected drug abusers in France and to determine predictors of successful therapeutic intervention. A total of 170 drug users were recruited from 40 French centers. Three centers recruited 66 participants (38.8%), and one to eight patients each were enrolled from 37 other centers (n=104). A sustained viral response (SVR) was seen in 65 (38.2%) patients. SVR rates were significantly higher in compliant than in non-compliant patients (43.5% versus 23.9%; P=0.019), in patients from high- rather than low-recruiting centers (54.5% versus 27.9%; P<0.001) and in patients receiving Buprenorphine rather than methadone (48.1% versus 21.8%; P=0.001). In patients, who completed both the treatment and follow-up (n=94), SVR rate was 57.4%. Buprenorphine substitution therapy and genotypes 2 or 3 HCV infection were associated with significantly higher rates of SVR (P<0.01, for both comparisons). In conclusion, successful care of hepatitis requires an active treatment policy of every center toward drug addicts. Additional studies are needed to explore the difference in SVR with methadone versus Buprenorphine therapy.     

Mortality in HIV‐infected injection drug users with active vs cleared hepatitis C virus‐infection: a population‐based cohort study

Summary. Acute hepatitis C virus (HCV) infection may lead to chronic HCV‐infection with detectable HCV RNA or to spontaneous clearance with no HCV RNA, but detectable HCV antibodies. It is unknown whether HCV RNA status is associated with mortality in HIV‐infected injection drug users (IDUs). We conducted a nationwide population‐based cohort study to examine the impact of HCV RNA status on overall and cause‐specific mortality in HIV‐infected IDUs. We computed cumulative mortality and used Cox Regression to estimate mortality rate ratios (MRR). We identified 392 HIV‐infected patients of whom 284 (72%) had chronic HCV‐infection (HCV RNA positive patients) and 108 (28%) had cleared the HCV‐infection (HCV RNA negative patients). During 1286 person‐years of observation (PYR), 157 persons died (MR = 122/1000 PYR, 95% CI: 104–143). The estimated 5‐year probabilities of survival were 0.58 (95% CI: 0.51–0.65) in the chronically HCV‐infected and 0.52 (95% CI: 0.40–0.63) in the cleared HCV group. Chronic HCV‐infection was not associated with overall mortality: MRR 0.85, 95% CI: 0.59–1.21. In HIV‐infected Danish IDUs, chronic HCV‐infection is not associated with increased mortality compared to patients who have cleared the infection.     

Occasional spontaneous clearance of chronic hepatitis C virus in HIV-infected individuals

The IL28B genotype has been found to have a strong influence on spontaneous clearance of acute HCV both in HCV mono- and HIV/ the HCV co-infected patients. Spontaneous clearance of chronic HCV without HCV treatment is rare. Here, we report on three chronic HCV cases co-infected with HIV with spontaneous clearance of their HCV infection, all with the IL28B CC genotype. These cases were derived from a surveillance of the total HIV/HCV co-infected cohort in Sweden (n = 466). The estimated frequency of spontaneous clearance of chronic HCV infection in our cohort was calculated to be 0.6–4.7%.     

Factors Associated With Rates of HBsAg Seroclearance in Adults With Chronic HBV Infection: A Systematic Review and Meta-analysis

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