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Methadone _ HCV

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					Methadone & HCV

   Up to 95% of methadone patients
    infected with HCV in SF Bay Area

   Difficult group to treat

   Methadone patients have been
    successfully received liver transplants
                                              1
Treating HCV – O.A.S.I.S.
   Started treatment program in 1999
   60 methadone patients

   Treatment program
       Education, peer support and concurrent
        medical monitoring



                                                 2
Patient Population
   61% Male
   Average age 10 years older than other
    studies = 50 yo.
   Diversity
       74% Caucasian
       16% African American
       10% Latino

                                        3
Patient Population –con’t
   54% diagnosed with depression,
    anxiety or both
   42% exhibit no psychiatric diagnosis
   29% exhibited cirrhosis by biopsy or
    platelet count <100,000
   Similar genotype distribution


                                           4
Results
   18% discontinued therapy – similar to
    regular trials
          8% - exacerbation of psychiatric disease
          8% due to side effects
          2% due to exacerbation of medical conditions.
   End of treatment response
          55% - encouraging data, but need to wait for
           sustained response rates.



                                                      5
Injection Drug Users (IDU’s)

   Injection drug users represent the
    largest group infected with HCV in U.S.

   40-95% of IDU’s infected with HCV
       Most S.F. Bay Area county testing at 90-
        95%

                                                   6
Urban Health Studies*

   Samples from San Francisco and East Bay

   Results - Demographics
          31% female, 66% African American, 6% Latino
          Median age ws 45 years
          Meridian duration drug injection was 25 years


    * Karen Seal, M.D. - author

                                                           7
Urban Health Studies
   Results – Seroprevalence

       1109 (92%) were anti-HCV +, but 22%
        cleared the virus on their own

       140 (12%) with HIV +

       132 (11%) had antibody to both HIV and
        HCV.

                                                 8
Urban Health Studies
   Behaviors of HCV+ IDU’s
       59% currently drinking one or more
        alcoholic drinks a day

       22% currently drinking 4 or more alcoholic
        drinks a day.




                                                9
Urban Health Studies
   34 IDU’s with HCV biopsied
    Results:
      Fibrosis Stage   number
      0                2        6%
      1                17       60%
      2                13       38%
      3                1        3%
      4                1         3%


    *Those with clinical cirrhosis were excluded

                                               10
Urban Health Studies
   Interface with treatment and testing
    programs among HCV+ IDU’s
   77% had received drug treatment
   96% previously had been tested for HIV
   37% previously had been tested for
    HCV


                                       11
Urban Health Studies
   Conclusions
       IDU’s have a high rate of HCV+
       Many injecting for 20-30 years
       Factors common among IDU’s may
        accelerate HCV-related liver disease:
            Co-infection with HIV (11%)
            Daily consumption of alcohol (59%)



                                                  12
Urban Health Studies -
Recommendations
   All IDU’s should be screened at drug tx,
    HIV testing and primary care centers
   If HCV positive, IDU’s should receive:
       Confirmatory HCV viral load testing to
        determine active infection
       Follow-up medical care for HCV
       Vaccination against HAV & HBV


                                                 13
Urban Health Studies – Con’t
   If HCV positive, IDU’s should receive:
       Counseling about alcohol use and referral
        to drug/alcohol tx if interested
       Information preventing transmission
       If interested, an evaluation for HCV tx.




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