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Hepatitis C testing and treatment among active drug users in Amsterdam: results from the DUTCH-C project

Lindenburg, Catharina E.A.a,*; Lambers, Femke A.E.a,*; Urbanus, Anouk T.a; Schinkel, Jankeb; Jansen, Peter L.M.d; Krol, Annekea; Casteelen, Gertyc; van Santen, Gerritf; van den Berg, Charlotte H.S.B.a,e; Coutinho, Roel A.e,g; Prins, Mariaa,e; Weegink, Christine J.d

European Journal of Gastroenterology & Hepatology: January 2011 - Volume 23 - Issue 1 - p 23–31
doi: 10.1097/MEG.0b013e328340c451
Original Articles: Hepatitis

Background Although hepatitis C virus (HCV) treatment has shown to be effective, uptake of treatment among active drug users is still low. The Drug Users Treatment for Chronic Hepatitis-C project aims to offer active drug users in Amsterdam HCV testing and treatment using a multidisciplinary approach.

Methods The study population comprises drug users participating in the Amsterdam Cohort Studies and drug users referred to the Drug Users Treatment for Chronic Hepatitis-C unit. Drug users were offered HCV testing and, if chronically infected, medical and psychiatric screening and HCV treatment. Various specialists collaborated to provide optimal care. We assessed test-uptake and treatment-uptake and outcomes.

Results Four hundred and ninety-seven Amsterdam Cohort Studies drug users were offered HCV testing: 449 out of 497 (90%) accepted. HCV antibodies were found in 267 out of 449 (60%): 183 out of 267 (69%) were HCV-viremic and 49 out of 183 (27%) were HIV-co-infected. Of the 134 HCV-monoinfected patients, 102 (76%) initiated additional medical screening and 44 started treatment by 1 July 2009. Sixty-two drug users referred from methadone clinics were also HCV-monoinfected, of whom 14 started treatment by 1 July 2009. In total 58 persons were treated: 16 (27%) with genotype 1 or 4, 42 (72%) with genotype 2 or 3. Eighty-four percent used methadone, 97% used drugs (heroin, cocaine or amphetamine) at least once in the 6 months before treatment, 19% were active injectors. Sixty-two percent used alcohol, 41% had psychiatric disease other than substance abuse. Of the 57 individuals with sufficient follow-up, 37 (65%) achieved sustained virological response.

Conclusion In a multidisciplinary setting, HIV-negative drug users with chronic HCV infection can be treated successfully despite active drug or alcohol use and psychiatric diseases. Therefore, access to HCV therapy using an integrated approach should be increased for this population.

aDepartment of Research, Cluster Infectious Diseases Public Health Service Amsterdam

bAmsterdam, Departments of Clinical Virology

cPsychiatry

dGastroenterology and Hepatology (AMC Liver Center)

eDepartment of Internal Medicine, (Division of Infectious Diseases, Tropical Medicine and AIDS, Center of Infectious diseases and Immunology Amsterdam (CINIMA)), Academic Medical Center, Amsterdam

fCluster of Mental Health Public Health Service Amsterdam, Amsterdam

gNational Institute of Public Health and the Environment, Center for Infectious Disease Control, Bilthoven, The Netherlands

Correspondence to Femke A.E. Lambers, MD, Department of Research, Public Health Service Amsterdam, PB 2200, 1000 CE Amsterdam, The Netherlands Tel: +31 20 555 5705; fax: +31 20 555 5533; e-mail: flambers@ggd.amsterdam.nl

DUTCH-C project and data partly presented previously at: (i) The 5th Annual International Conference on Urban Health, 2006, The Netherlands (oral presentation abstract). (ii) The 12th International Symposium on Viral Hepatitis and Liver Disease, 2006, France (poster presentation). (iii) The 57th Annual Meeting of the American Association for the Study of Liver Diseases, 2006, U.S. (poster presentation). (iv) The 18th International Conference on the Reduction of Drug Related Harm, 2007, Poland (oral presentation). (v) The 3rd International Workshop on HIV and Hepatitis C co-infection, 2007, France (poster presentation). (vi) The 43rd annual meeting of the European association for the study of the liver, 2008, Denmark (poster presentation). (vii) The 44th annual meeting of the European association for the study of the liver, 2009, Milan (poster presentation). (viii). The 1st international symposium on Hepatitis care in substance users, Switzerland, 2009 (oral presentation), and published as abstract in: (i) Hepatology, 2006, Vol. 44, supplement 1. (ii) The Journal of Hepatology, 2008, Vol. 48, supplement 2, page s285, abstract 764. (iii) The Journal of Hepatology, 2009, Vol. 50, supplement 1, page s231, abstract 629.

*Catharina E.A. Lindenburg and Femke A.E. Lambers have contributed equally to the writing of this article and are equal first authors

Received July 15, 2010

Accepted September 21, 2010

© 2011 Lippincott Williams & Wilkins, Inc.