Hepatitis C treatment candidacy and outcomes among 4318 US veterans with chronic hepatitis C virus infection - Does a history of injection drug use matter?

Background/Goals: Many patients with a history of injection drug use (IDU) are excluded from hepatitis C virus (HCV) treatment. This prospective multicenter study aimed to determine the impact of IDU history on HCV treatment candidacy and outcomes. Study: Between 1999 and 2001, 4318 HCV-infected patients seen at 24 VA Medical Centers were evaluated for HCV treatment candidacy and followed prospectively. Univariate and multivariate logistic regression analyses were used to determine whether an IDU history was associated with HCV treatment candidacy, HCV treatment acceptance, early treatment discontinuation, and virologic response. Results: Of 4318 participants, 2611 (61%) reported an IDU history. IDU history was not significantly associated with HCV treatment candidacy, acceptance, early discontinuation of therapy, or virologic response (all P values nonsignificant). Instead, reduced HCV treatment candidacy was independently associated with low-income [odds ratio (OR) = 1.46, 95% confidence interval (CI) = 1.22-1.74), education <= 12 years (OR = 1.23, 95% CI = 1.03-1.46), and alcohol consumption >= 3 drinks/d (OR = 2.08, 95% CI = 1.68-2.57), whereas early discontinuation of HCV therapy was independently associated with low-income and consuming >= 3 alcoholic drinks/d. Conclusions: A history of IDU was not associated with HCV treatment candidacy or outcomes, supporting national guidelines to evaluate former IDUs on a case-by-case basis for HCV treatment.