Access to care of patients with chronic hepatitis C virus infection in a university hospital: Is opioid dependence a limiting condition?

Abstract

Background We aimed to examine access to care of opioid-dependent patients with chronic hepatitis C. Methods A standardized form was used to conduct a retrospective survey from 1999 to 2003 in a French university hospital. All HCV RNA positive in- or outpatients who had not had a liver biopsy or anti-HCV treatment were included. Opioid-dependence was defined as active opioid drug use or being on opioid substitution treatment. Results The survey included 580 patients; 137 (23.6%) were opioid-dependent. Fewer patients with than without current opioid dependence had had genotyping (40.1% versus 67.7%, p < 0.001), liver biopsy (51.8% versus 62.8%, p = 0.022), and anti-HCV treatment (8.8% versus 18.3%, p = 0.008). Genotyping was independently, negatively, associated with: (1) current opioid-dependence (OR = 0.3, 95%CI = 0.2–0.5), (2) former opioid-dependence (OR = 0.5, 95%CI = 0.3–0.9), (3) unemployment (OR = 0.5, 95%CI = 0.3–0.7), and (4) HCV infection discovered by screening (OR = 0.5, 95%CI = 0.3–0.7). Access to liver biopsy was independently, negatively associated with current opioid-dependence (OR = 0.6, 95%CI = 0.4–0.9), but positively associated with alcohol consumption (OR = 2.0, 95%CI = 1.2–3.4) and abnormal ALT level (OR = 2.2, 95%CI = 1.5–3.2). Access to anti-HCV treatment was independently, negatively associated with HCV infection discovered by screening (OR = 0.5, 95%CI = 0.3–0.9), but positively associated with moderate hepatitis (OR = 6.8, 95%CI = 2.8–16.8), extensive fibrosis or cirrhosis (OR = 12.3, 95%CI = 5.5–27.5), abnormal ALT level (OR = 2.1, 95%CI = 1.3–3.6) and age (40–64 years) (OR = 1.9, 95%CI = 1.0–3.4). Conclusions Genotyping and liver biopsies were performed less frequently on current opioid dependent patients. Absence of genotyping was also independently associated with unemployment and former opioid-dependence. Alcohol consumption or abnormal ALT levels favored access to biopsy. Histological grade strongly conditioned access to anti-HCV treatment.