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Together … to Take Care: Multidisciplinary Management of Hepatitis C Virus Treatment in Randomly Selected Drug Users With Chronic Hepatitis

Curcio, Fabio MD; Di Martino, Filomena MD; Capraro, Clara; Angelucci, Federico MD; Bulla, Fabio MD; Caprio, Nunzio MD; Cascone, Angela MD; D'Ascoli, Gelsomina MD; Focaccio, Flora MD; Gaveglia, Michela MD; Longobardo, Anna MD; Martini, Salvatore MD; Masucci, Salvatore MD; Morra, Alessandra MD; Pasquale, Giuseppe MD, PhD; Pisapia, Raffaella MD; Plenzik, Marinella; Veneruso, Ciro; Villano, Giuseppina; Russo, Manlio MD; De Rosa, Giuseppe MD; Filippini, Pietro MD, PhD

Journal of Addiction Medicine: December 2010 - Volume 4 - Issue 4 - p 223-232
doi: 10.1097/ADM.0b013e3181cae4d0
Original Article
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Hepatitis C Virus (HCV) infection is treated with peg-interferon α2a or α2b and ribavirin. International studies show that drug user adherence to treatment is 40% to 60% and increases if the patient is in addiction treatment. The aim of the Together To Take Care (TTTC) study was to achieve better adherence to HCV therapy in randomly selected drug users, who are considered “difficult to treat.” The secondary aim of the TTTC Study Group was to standardize a method for a multidisciplinary management of the liver disease in drug users. The TTTC group data were matched with a control group. Adherence: The 93.7% of patients followed therapy prescribed; of the patients infected by HCV genotype (gt) 3, all completed therapy as scheduled. For the 48-week treatment group, 66.7% of patients completed therapy (2 of 9 patients stopped treatment for breakthrough). Toxicological results: 10 (62.5%) patients were negative in the toxicological tests (opiates, cocaine, and alcohol). Virological results: 8 of 16 patients were infected by HCV gt 1, and 8 were infected by gt 3; 2 of 16 (12.5%) patients were human immunodeficiency virus (HIV) coinfected (1 HCV gt 1a and 1 HCV gt 3). All patients: 11 of 16 (68.75%) patients were HCV ribonucleic acid undetectable 24 weeks after completing therapy (sustained virological response, SVR). Gt 1: 4 of 8 (50.0%) showed SVR. Gt 3: 7 of 8 (87.5%) showed SVR. Overall, the HCV gt 3 patients had 87.5% probability of SVR, whereas gt 1 patients had 50% probability of SVR (gt 3/gt 1 patients odds ratio = 7). The results were analyzed by Fisher exact test. Our results show that good healthcare management plays an important role in increasing patients' adherence to therapy. In the project “TTTC,” the patients work with the physicians to take responsibility for their health and acquire self-efficacy and self-awareness, thanks to the special care.

From the U.O. SERT D.S. 31 ASL Napoli 1 Centro (FC, CC, GD, FF, MG, AL, SMasucci, MP, CV, GV, GDR), P.O. Gesù e Maria; D.A.I. Malattie Infettive e Medicina Interna S.U.N. (FDM, FB, NC, AC, SMartini, GP, RP, PF); and U.O. Salute Mentale D.S.B. 51 ASL Napoli 1 Centro (FA, AM, MR), P.O. Gesù e Maria, Napoli, Italy.

Received for publication July 3, 2009; accepted November 9, 2009.

Send correspondence and reprint requests to Fabio Curcio, MD, U.O.SER.T D.S. 31 ASL Napoli 1 Centro, Ospedale Gesù e Maria, Salita Tarsia, 93-80135 Napoli, Italy. e-mail: itinerari2008@alice.it

© 2010 American Society of Addiction Medicine