Treating Hepatitis C in Treating Hepatitis C in Methadone Patients:Methadone Patients:

With Planning, it Works! With Planning, it Works!

Patricia Perkins, MS, MPHIndependent Healthcare Consultant

Community Advisory Board Member

Organization to Achieve Solutions in Substance-Abuse (O.A.S.I.S.)

www.oasisclinic.org

IFN alfa-2b/RBV: IFN alfa-2b/RBV: Summary of Predictive Factors for a SVRSummary of Predictive Factors for a SVR

Weight > 75 kgWeight 75 kg

High Fibrosis

Low Fibrosis

Male

Female

Age > 40

Age 40

High HCV RNA

Low HCV RNA

Genotype 1

Genotype 2 or 3

Increasing usefulnessin predicting

sustained response

20 40 60 80

% Sustained Virologic Response

McHutchison JG et al. Semin Liver Dis. 1999;19(suppl 1):63.

Questions: some of the many…Questions: some of the many… Does methadone use affect HCV treatment: dosing

levels? Does psychiatric disease in IDUs affect HCV treatment?

Should all patients be on SSRI’s? Does length of sobriety affect HCV treatment? Does alcohol use [during tx] affect HCV treatment? Does illicit drug use [during tx] affect HCV treatment?

O.A.S.I.S., Oakland, CA O.A.S.I.S., Oakland, CA Medical Care FOR IDUsMedical Care FOR IDUs

Addresses special needs of IDU– Distrust of authority– High prevalence of psychiatric illness– Psychosocial problems– Limited or Inconsistent Social Support– High level of misinformation about HCV and

most other medical illnesses

Group Treatment Model:Group Treatment Model:One Stop ShoppingOne Stop Shopping

EducationPeer supportMedical monitoring

O.A.S.I.S. HCV PatientsO.A.S.I.S. HCV Patients

>900 patients screened to date: from 5-8 area MMTs and other persons with DU histories– All with Liver Function Tests– Most with PCR (polymerase

chain reaction) and/or genotype>100 treated

O.A.S.I.S. HCV Patient O.A.S.I.S. HCV Patient DemographicsDemographics

51% male vs 66%47 yr vs 42 yr58% Caucasian vs 95%29 yr infected vs 17 yr61% psychiatric dx29% cirrhosis vs 4%

Histology in Treated MMTHistology in Treated MMT

2.01

1.32

2.412.6

0

0.5

1

1.5

2

2.5

3

3.5

4

Inflammation Fibrosis

ME

TA

VIR

Sco

re

Typical

MMT

ALT vs Liver FibrosisALT vs Liver Fibrosis

0

5

10

15

20

25

30

0 0.5 1 1.5 2 2.5 3 3.5 4

Fibrosis Stage

% P

ati

en

ts

PsNlAlt(n=23)

Elev ALT(n=27)

Interim Interferon/Ribavirin Interim Interferon/Ribavirin Treatment ResultsTreatment Results

20

51

41

24

54

29

0

10

20

30

40

50

60

Dropouts ETR SVR

% P

ati

en

ts Non-OpioidDependent

MMTn=67

n=59

OASIS non-MMT vs OASIS MMT OASIS non-MMT vs OASIS MMT

29

54

29

48

010

2030

4050

60

ETR SVR

% P

atie

nts Non-MMT

MMTn=67

n=17 n=59

n=22

The Impact of Psychiatric The Impact of Psychiatric Disease in MMTDisease in MMT

p=0.46

58

37

54

22

0

10

20

30

40

50

60

70

ETR SVR

% P

ati

en

ts

No Psych

Psych

n=22

n=41

n=37

n=26

The Impact of Alcohol Use on The Impact of Alcohol Use on HCV TreatmentHCV Treatment

p=0.46

n=57n=45

n=12

57

29

38

25

0

10

20

30

40

50

60

ETR SVR

% P

ati

en

ts

No EtOH

EtOHn=47

n=13n=45

n=12

Impact of Drug Use During HCV Impact of Drug Use During HCV TreatmentTreatment

n=57 n=6n=37

n=17 n=4

n=57n=17

n=40

61

3235

20

0

10

20

30

40

50

60

70

ETR SVR

% P

atie

nts

No Drugs

Drugs

n=20

n=39

n=37n=20

Impact of Illicit Drug Quantity Impact of Illicit Drug Quantity on HCV Outcomeson HCV Outcomes

n=57 n=6n=37

n=17 n=4

n=7

n=40 n=6n=4

n=7

61

32

57

29

40

20

0 00

10

20

30

40

50

60

70

ETR SVR

% P

atients None

Rare

Intermittent

Regular

n=39n=7

n=5

n=7

n=37n=7

n=5 n=7

Impact of Pretreatment Drug Impact of Pretreatment Drug SobrietySobriety

n=11

n=9n=12

n=25

59

30

56

3733

17

0

10

20

30

40

50

60

70

ETR SVR

% P

ati

en

ts

6mo + up

>0 - <6mo

0n=39

n=9

n=12n=37

n=8

n=12

Treatment Results: Treatment Results: No Preexisting No Preexisting Psych, No Drugs, No AlcoholPsych, No Drugs, No Alcohol

51

41

69

50

0

20

40

60

80

100

ETR SVR

% P

ati

en

ts

Non-Opioid Dependent

MMTn=13

n=12

Early Conclusions:Early Conclusions: HCV treatment in MMT is safe, tolerable, and

efficacious. Psychiatric illness, intermittent drug use, and alcohol

use have a modest negative impact on treatment outcomes in MMT.

Regular drug use may impact substantially on virologic outcomes, and therefore relapse to drug use during HCV treatment should lead to aggressive substance abuse intervention.

AcknowledgementsAcknowledgements

O.A.S.I.S. staff, Board, CAB & volunteers***Schering Oncology-BiotechParticipating MMT clinics

– BAART– SAACS– 14th St. Clinic– HAART

Knowledge is power.

Saber es el poder.

Please Join our Fight!Future Presentations will continue to be posted on our website: http://www.oasisclinic.org