Objectives: Injection drug use (IDU) is the primary mode of hepatitis C virus (HCV) transmission/acquisition in the US. Among IDUs, many of whom receive methadone maintenance treatment (MMT), prevalence rates exceed 50%. Controversy exists regarding whether HCV(+) patients require higher doses of methadone than HCV (-) patients. We explored the relationship of methadone dose, HCV infection status and liver inflammation among MMT patients.
Methods: A chart review was conducted of a random selection of patients enrolled at a Bronx MMT program. Patients in treatment less than six months were excluded. Data collected included current methadone dose and date and result of most recent aspartate (AST) and alanine (ALT) aminotransferase levels. Findings in HCV (+) and HCV(-) patients were compared.
Results: Of 74 eligible patients reviewed, 45 (61%) were HCV(+). Median (range) methadone dose was 80 (10-200) and 90 (5-200) mgs among HCV (+) and HCV (-) patients, respectively (p=NS). HCV (+) patients (n=20) with elevated liver enzymes (AST>=50) received lower methadone doses (median=70 mg) than those (n=25) with liver enzymes in the normal range (p=.04, Kruskal-Wallis test). No such association was present among HCV(-) patients.
Conclusions: HCV infection alone does not appear to alter patients’ methadone dose requirements. However, hepatic inflammation in the presence of HCV infection, but not in its absence, was associated with lower methadone requirements. Possibly, hepatic infection with HCV may disrupt intrahepatic methadone metabolism. Practitioners caring for this high-risk population must be alert to the possibility that HCV-associated hepatic inflammation may reduce patients’ methadone dose requirements.
Learning Objectives: At the conclusion of the session, the participant (learner) in this session will be able to: describe possible associations bewtween hepatitis C virus and methadone dose requirements.
Keywords: Hepatitis C, Methadone Maintenance
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.