Session Title: Category 5g. VIRAL HEPATITIS: g. HEPATITIS C - CLINICAL (THERAPY)
Presentation Date: Apr 15, 2010
HIGH VIRAL RESPONSE IN A MULTIDISCIPLINARY NETWORK NOT ORGANIZED UNDER ONE ROOF FOR ANTIVIRAL MANAGEMENT OF CHRONIC HEPATITIS C VIRAL PATIENTS INFECTED AFTER SUBSTANCE USE
S. Bourgeois1*, W. Schrooten2,3, G. Robaeys4,5,6, Belgian Network on Hepatitis in Substance Users
1Gastro-enterology, ZNA Stuivenberg, Antwerpen, 2Ziekenhuis Oost Limburg, Genk, 3UHasselt, Diepenbeek, 4Gastroenterology and Hepatology, Ziekenhuis Oost Limburg, Genk, 5Hepatology, UZ Leuven, Leuven, 6Medicine, UHasselt, Diepenbeek, Belgium. *firstname.lastname@example.org
Background and aims: The antiviral management of chronic hepatitis C (CHC) viral patients infected after intravenous substance use (IVDU) is improved by organizing multidisciplinary networks, frequently under one roof (UOR). However, in densely populated regions multidisciplinary collaborations are organized not under one roof (nUOR). The outcome of nUOR collaboration is not studied. Therefore, the outcome of antiviral management of CHC patients infected after IVDU in this setting was investigated.
Methods: In a prospective, monocentric, cohort study ( antiviral treatment inclusion period from 12 2001 to 12 2008), the SVR in CHC IVDU nUOR treated patients was compared to CHC non-IVDUs. In an intensively collaborating nUOR network in Vlaanderen, three addiction clinics were located within five kilometres from one hepatology unit. The CHC IVDU patients who were stable on substitution therapy and well motivated, could be referred to the hepatologist. During therapy the hospital pharmacy monitored adherence, the addiction centers provided substitution maintenance therapy. In problematic cases intensive communication between the hepatology service and the addiction center was organised.
Results: In 549 HCV-ab + patients referred to the hepatology unit, encompassing 338 IVDUs (62%) and 211 non-IVDUs, 257 (76%) IVDUs and 156 (74%) non-IVDUs were HCV-RNA positive. In 214 IVDUs and 118 non-IVDUs with elevated serum transaminases resp. 125 (58%) and 79 (67%) started antiviral medication. There was no difference in the rate of treatment start between the two groups: the main reasons in IVDUs for not starting were : uncontrolled alcohol (n=14-15%) and substance abuse (n=2-2%), uncontrolled psychiatric disease (n=3-3%) with suicidal ideation (n=1), social problems (n=7-7%),imprisonment (5-5%). In the treated population, 79% of the IVDUs was male versus 58% among the non-IVDUs. Median age was resp. 35 and 41y, with a median viral load of resp. 2,17 and 1,48. Using intention-to-treat analysis, SVR was obtained in 79 (63%) of the IVDUs versus 38 (48%) of the non-IVDUs (p=0,03).
Conclusion: A very high uptake and SVR can be obtained in chronic hepatitis C patients infected after substance use in a non-under one roof multidisciplinary collaboration. Especially intense collaboration and not the location of the management is of importance.