Abstract: Background: Many intravenous opiate users are infected with hepatitis C virus (HCV) but few are treated. Although this complies with various guidelines, virtually no published evidence supports such a recommendation. Patients and Methods: In a multicenter study, HCV-infected patients in opiate maintenance treatment programs received interferon plus high- or low-dose ribavirin (1000/1200 mg or 600 mg). HIV-coinfected patients were not included. Endpoints were feasibility, efficacy, side effects, and reasons for dropout. Results: Of the 420 patients who tested positive for HCV, 27 (6%) were enrolled; 393 (94%) either failed to meet the inclusion criteria or refused treatment. Virologic end-of-treatment response was achieved in 12/27 patients, and sustained response in 13/27 (48%). Response depended on viral genotype, not ribavirin dose. The two doses of ribavirin did not differ in their side effects. Conclusion: In a small fraction of HCV-infected intravenous drug users in an opiate maintenance treatment program, antiviral therapy was feasible, safe and effective. The success rate was comparable to that achieved in controlled studies that excluded drug users.

Abstract: Les professionnels de la santé sont exposés par leur activité au risque de transmission d’agents infectieux par le sang (VIH, VHB – virus de l’hépatite B, VHC – virus de l’hépatite C). La vaccination contre l’hépatite B a permis de diminuer considérablement les infections par ce virus dans le secteur sanitaire. Il n’existe en revanche pas de vaccination contre le VIH et le VHC. De 1997 à 2001, 6 infections par le VHC ont été rapportées en Suisse parmi le personnel de santé, soit 1,8% des expositions accidentelles à du sang VHC positif (séroconversions documentées). Une piqûre d’aiguille est à l’origine de tous les cas. Aucune transmission par exposition des muqueuses (bouche, yeux) n’a été mise en évidence. La déclaration systématique des accidents exposant au sang est un instrument essentiel pour améliorer la prévention et la prise en charge des expositions professionnelles au VHC.

Abstract: Aim of the Study: To assess the long-term hepatitis C (HCV) treatment outcome in former injecting drug users (IDUs). Materials and Methods: A long-term follow-up of 27 former IDUs who had been successfully treated for chronic hepatitis C was performed. These patients represented ailiDUs who had obtained a sustained virological response in a Norwegian HCV treatment trial. The patients had been treated with interferon-a alone or in combinatlon with ribavirin. At 5 years’ follow-up the 27 IDUs were retested for HCV RNA and risk behaviour for HCV transmission after treatment was assessed. In the control group ail 18 non-IDUs who had obtained a sustained virological response in the same treatment trial were included. Results: At follow-up 13-82 months (median 64) after the end of treatment only one case of probable reinfection was seen among the 27 IUDs. No reoccur- rence of HCV was observed in the control group. The IDU who was HCV RNA positive at follow-up had continued injecting drugs and reported frequent needle sharing. At follow-up HCV of genotype 1a was detected in contrast to genotype 1b before treatment indicating that this patient was reinfected with HCV. A return to injecting drug use occurred in 9 (33%) of 27 IDUs. Conclusion: The long-term outcome of HCV treatment in former IDUs was excellent. Despite frequent reinitiation of drug injection ail but 1 remained HCV RNA negative.