Efficacy of combined antiviral therapy with pegylated interferon α-2a and ribavirin for chronic hepatitis C infection in intravenous drug users

• Published in: Srpski arhiv za celokupno lekarstvo Vol. 138; no. 1-2; pp. 43 - 49
• Main Authors: Ruzic, Maja, Fabri, Milotka, Klasnja, Biljana, Pobor, Marta, Svarc, Daniela, Jovelic, Aleksandra, Fabri, Izabela
• Format: Journal Article
• Language: English
• Published: Serbian Medical Society 2010
• Subjects: chronic hepatitis C; intravenous drug users; pegylated interferon alfa; ribavirin
• ISSN: 0370-8179; 2406-0895
• DOI: 10.2298/SARH1002043R

Introduction. Hepatitis C Virus infection represents not just a medical, but also a socio-economic problem. It is estimated that among 170 million infected, 60% belongs to the category of intravenous drug users (IDUs). Objective. The aim of this paper was to compare the response to the combined therapy of pegylated interferon alfa 2a and ribavirin, in the group of patients with HCV infection who were intravenous drug users (IDUs) and in patients who were identified in the other way of transmission of HCV. Also to identify the influence of the therapy on diseases of addiction, during the course of HCV infection and on the effects of the combined therapy of pegylated interferon alfa 2a and ribavirin. Methods. We conducted a retrospective-prospective study, on 60 patients, treated with combined antiviral therapy-pegylated interferon alfa 2a and ribavirin. 30 patients were from the group of IDUs, and 30 patients from other epidemiological groups. Results. There were significant differences between the age of the patients (30.2?7.1 vs. 39.3?11.2 years; p=0.002), but no significant difference in the duration of the HCV infection between the two groups of patients (8.9?7.4 vs. 13.1?7.0 years; p>0.05). A large number of the patients in the group of IDUs had a problem with the abstinence of the drug abuse. In this group, there was the influence of alcohol (30%) and other substances with potential hepatotoxicity: marihuana (23.3%) and psycho-active drugs (73.6%). Staging of the liver fibrosis was not influenced by those two parameters and was similar in both groups (p>0.05). The genotype 3a was dominant in intravenous drug users (50.0%) and genotype 1b in the control group of the patients (76.6%). In both groups, SVR was achieved at a higher percentage (86% vs. 70.00%; p>0.05), but among the intravenous drug users the relapses of HCV infection were at a lower percentage (3.3% vs. 20.0%; p=0.044). Side effects were noticed in solitary cases in both of the examined groups, but severe side effects were found only in the control group of the patients. Relapse of drug abuse was noticed in 6.66% of cases. Conclusion. We have registered that the group of intravenous drug users has the same or even better response to the antiviral therapy than other epidemiological groups and that the use of drugs does not change the course of HCV infection. Uvod. Infekcija virusom hepatitisa C danas nije samo zdravstveni, vec i socijalno-ekonomski problem. Procenjuje se da je u svetu oko 170 miliona ljudi obolelo od ove infekcije, a da 60% obolelih pripada kategoriji intravenskih zavisnika od opijata. Cilj rada. Cilj rada je bio da se utvrdi da li postoje razlike u odgovoru na primenu kombinovane antivirusne terapije pegilovanim interferonom alfa-2a i ribavirinom u lecenju hronicnog hepatitisa C u grupi zavisnika od opijata u odnosu na grupu bolesnika s ovom infekcijom bez anamnestickih podataka o upotrebi opijata, odnosno da se ispita uticaj lekova koji se primenjuju u lecenju bolesti zavisnosti na tok hronicnog hepatitisa C i uspeh kombinovane antivirusne terapije. Metode rada. Retrospektivno-prospektivna studija je obuhvatila 60 ispitanika koji su na osnovu anamnestickih podataka o intravenskoj primeni opijata svrstani u ispitivanu i kontrolnu grupu. Rezultati. Bolesnici zavisnici od opijata bili su mladji od ispitanika kontrolne grupe (30,2?7,1 prema 39,3?11,2 godina; p=0,002), ali je infekcija trajala ujednaceno (8,9?7,4 prema 13,1? 7,0 godina; p>0,05). Zavisnici od opijata su koristili alkohol (30%), marihuanu (23,3%) i psihofarmake (73,3%), ali to nije uticalo na napredovanje hronicnog hepatitisa C (p>0,05). Utvrdjeno je da je genotip 3a dominantan u grupi zavisnika od opijata (50,0%), a genotip 1b u kontrolnoj grupi bolesnika (76,6%). U obe posmatrane grupe je postignut visok nivo stabilnog virusoloskog odgovora (86% prema 70%; p>0,05%), ali je u grupi zavisnika od opijata zabelezen manji postotak relapsa infekcije virusom hepatitisa C (3,3% prema 20,0%; p=0,044). Blaza nezeljena dejstva antivirusne terapije su se ispoljila kod nekoliko bolesnika obe grupe, dok su teza nezeljena dejstva zabelezena samo u kontrolnoj grupi. Relaps bolesti zavisnosti tokom lecenja nastupio je kod 6,6% bolesnika. Zakljucak. Zavisnost od opijata nema uticaja na tok hronicnog hepatitisa C i ishod antivirusne terapije.