Addicts with chronic hepatitis C: Difficult to reach, manage or treat?

Table 1 Main baseline characteristics of 162 hepatitis C antibody+ illicit drug users selected by physicians operating in six Territorial Addiction Service in the District of Brescia and comparison with 39 hepatitis C antibody+ illicit drug users accepting antiviral therapy n (%)

Patient characteristics	Selected by SerT (n = 162)	Accepting therapy (n = 39)	P value
Male gender	135 (83)	27 (69)	0.8152
Age, yr, mean ± SD	38 ± 7	39 ± 6	0.8888
Spoken language: Italian	152 (94)	33 (85)	0.0912
Place of birth			0.1502
Italy	147 (91)	32 (82)
EU	5 (3)	2 (5)
Non-EU	10 (6)	5 (13)
Level of education	(n = 151)		0.8320
≤ 8 yr of school	118 (79)	30 (77)
High school diploma	32 (21)	8 (21)
University degree	1 (0)	1 (2)
	(n = 149)		1.0000
Unemployed	49 (33)	13 (33)
Chronic associated conditions	41 (25)	11 (28)	0.6888
Cardiovascular	5 (3)	2 (5)
Respiratory	4 (2)	1 (3)
Allergic	2 (1)	1 (3)
Psychiatric	19 (12)	3 (8)

SerT: Territorial Addiction Service.

Table 2 Type of addiction and opiate substitution treatment among the hepatitis C antibody+ illicit drug users selected by the Territorial Addiction Service and comparison with hepatitis C antibody+ illicit drug users accepting antiviral therapy n (%)

	Selected by SerT (n = 162)	Accepting therapy (n = 39)	P value
Alcohol
Active	11 (7)	4 (10)	0.4972
Partial remission	5 (3)	0 (0)	0.5867
Total remission	23 (14)	10 (26)	0.0944
Cannabis
Active	7 (11)	2 (5)	0.0590
Partial remission	3 (2)	1 (3)	0.5811
Total remission	4 (2)	3 (8)	0.1344
Cocaine
Active	33 (20)	3 (8)	0.0038
Partial remission	6 (4)	1 (3)	1.0000
Total remission	39 (24)	12 (31)	0.4150
Heroin
Active	48 (30)	6 (15)	0.1059
Partial remission	19 (12)	5 (13)	0.7885
Total remission	74 (46)	23 (59)	0.0647
Duration of intravenous drug use, yr, mean ± SD (range)	(n = 98)	(n = 33)
	13 ± 8 (7-34)	13 ± 9 (6-32)	0.8588
Opiate substitution treatment	126 (78)	28 (72)	0.4089
Methadone, mg, mean ± SD	107 (66), 41 ± 22	19 (60), 46 ± 26	0.0642
Buprenorphine, mg, mean ± SD	19 (12), 5 ± 3	9 (23), 6 ± 4	0.0751

A smoking habit was concomitant in 100% of patients: < 5 cigarettes/d in 4%, 5-10 cigarettes/d in 12%, 11-20 cigarettes/d in 54% and > 20 cigarettes/d in 30%. SerT: Territorial Addiction Service.

Table 3 Attitudes toward/knowledge about hepatitis C virus infection among the hepatitis C antibody+ illicit drug users selected by the Territorial Addiction Service in comparison with hepatitis C antibody+ illicit drug users accepting antiviral therapy n (%)

Patient attitudes/knowledge	Selected by SerT (n = 162)	Accepting therapy (n = 39)	P value
Source of HCV information	(n = 150)	(n = 33)	NS
Other HCV patients	44 (29)	11 (33)
Health operators	72 (48)	18 (55)
Press	54 (36)	14 (42)
Web	15 (10)	6 (18)
Television	62 (41)	16 (48)
None	25 (17)	6 (18)
Feelings toward information
Complete	(n = 139) 72 (52)	(n = 32) 15 (47)	0.6964
Confident	(n = 131) 30 (23)	(n = 31) 16 (52)	0.0033
Reassuring	(n = 130) 68 (52)	(n = 28) 14 (50)	0.8381
Attitudes toward HCV therapy
Total fright	(n = 129) 3 (2)	(n = 29) 0 (0)	1.0000
Moderate worries	(n = 141) 102 (78)	(n = 32) 25 (78)	0.5271
Positive expectations	(n = 125) 70 (56)	(n = 28) 18 (64)	0.5271

HCV: Hepatitis C virus; SerT: Territorial Addiction Service.

Table 4 Main baseline clinical and laboratory characteristics of treated illicit drug users

Characteristics	n = 39
BMI (kg/m2), M (range)	24.3 (17.6-34.6)
Duration of HCV infection (yr), M (range)	5 (1-21)
Duration under 1 yr	14 (36)
Duration of IDU status (yr), M (range)	12 (1-32)
Active IDU	14 (36)
History of depression	11 (28)
Pathologic Hamilton score
Anxiety	10 (26)
Depression	8 (21)
AUDIT-C at-risk score	7 (18)
Leucocytes (n/mm3), M (range)	6960 (3960-11960)
Haemoglobin (g/dL), M (range)	15.5 (11.8-17.7)
Platelets	224 (106-421)
ALT index (value/u.l.n.), M (range)	2.5 (0.5-16.4)
AST index (value/u.l.n.), M (range)	2.0 (06-6.6)
GGT index (value/u.l.n.), M (range)	1.2 (0.3-13.9)

HCV: Hepatitis C virus; IDU: Illicit drug user; M: Male; BMI: Body mass index; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; GGT: Gamma glutamyltransferase.

Table 5 Main baseline features potentially affecting the response to antiviral therapy in treated illicit drug users

Features	Prevalence
Age over 40 yr	54%
Males	85%
BMI over 25 kg/m2	36%
Previous unsuccessful interferon treatment	21%
Unfavourable HCV genotype (1 or 4)	60%
HCV viral load > 5.6 Log (IU/mL)	62%
HBcAb positivity	40%
Ultrasonography suggestive of steatosis	44%
Ultrasonography suggestive of cirrhosis	17%

HBcAb: Hepatitis B core antibody; HCV: Hepatitis C virus; BMI: Body mass index.