Dr. Andrew H. Talal. Image credit: Douglas Levere, University at Buffalo
People who inject drugs and are enrolled in a drug treatment program are open to receiving education and treatment for hepatitis C, according to new research by investigators at several institutions, including Weill Cornell Medical College.
The finding, published in May in the Journal of Addiction Medicine, offers hope to providers that they can reach these patients, who are at high risk for contracting the viral infection.
"One of the most important findings of this work is that people who inject drugs do want to be educated about the disease and that education is associated with willingness to be treated," says senior author Dr. Andrew H. Talal, adjunct associate professor of medicine at Weill Cornell Medical College and professor of medicine in the Division of Gastroenterology, Hepatology and Nutrition at the University at Buffalo. First author is Dr. Marija Zeremski, a senior research associate in medicine at Weill Cornell and a research assistant professor of medicine at UB.
Injection drug use is a primary pathway to hepatitis C infection, with the prevalence of the virus among intravenous drug users as high as 80 percent. While infection is often asymptomatic, 75 to 80 percent of those infected will develop chronic infection that can eventually progress to liver cirrhosis and liver cancer, potentially requiring liver transplantation. In order to be considered for a liver transplant, however, drug users are required to be sober for at least six months.
The study was based on a survey of 320 patients enrolled in a New York City-based methadone-treatment program. Nearly half of them reported that they had tested positive for hepatitis C, and more than three-quarters expressed willingness to participate in hepatitis C-related education and to receive treatment for the virus.
In surveys, study participants reported fear of side effects of the medication Interferon as the key factor underlying their hesitancy to accept treatment. While Interferon-based therapies are effective in eliminating hepatitis C infection in half of those who take it, the drug can cause various side effects, including fatigue, fever, nausea, anorexia, muscle pain, hair loss, insomnia, depression and irritability.
"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," Dr. Talal said. “Most importantly, there has been a lack of education about the disease, a fear of side effects of interferon, discomfort in conventional health care venues and a lack of awareness of the status of the infection."
The findings also reinforced Dr. Talal’s previous research findings demonstrating that treatment of addiction significantly enhances the ability of people who use drugs to complete HCV therapy.
"A major change in the attitudes of people who use drugs is due to knowledge about greatly improved treatment efficacy and the ability to provide HCV treatment at the same site as the substance abuse treatment," Dr. Talal said.