Barriers to interferon-α therapy are higher in intravenous drug users than in other patients with acute hepatitis C

Background/Aims: Treatment with interferon-alpha (IFN-alpha) may eradicate HCV in most acute hepatitis C patients, thus preventing chronic hepatitis and avoiding less efficacious combination therapy. Methods: In a prospective study, we evaluated the impact of barriers to successful start and completion of treatment of acute and subacute (< 12 months from infection) hepatitis C with pegylated IFN-alpha(2b),, 1.5 mu g/kg, QW, for 24 weeks. Results: Out of 27 patients (22 were active intravenous drug users [IVDU]), 5 cleared HCV spontaneously. Antiviral treatment was indicated in 22 patients: six refused therapy for fear of side effects, whereas two others were lost to observation. Eight patients completed the treatment or received > 80 % of the scheduled drug: seven (88 %) were sustained virological responders 24 weeks after the end of treatment. Six patients (all IVDU) stopped prematurely due to side effects: only one had a sustained virological response. Based on an intent-to-treat analysis, and considering all 14 patients in whom at least one dose of drug was administered, only 8 (57 %) became sustained virological responders. Conclusions: Treatment of acute hepatitis C with pegylated IFN-alpha is highly beneficial, but its effectiveness is affected by a poor rate of acceptance and/or adherence to currently available regimens, especially in IVDU and women. (c) 2004 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.