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Heroin Addiction and Related Clinical Problems: 2014, 16, 1 (pages: 41 - 44)

Prevalence of HCV infection and adherence to DOT therapy in Italian and non-Italian iv drug users in Rome, Italy

Nosotti L., Fagetti R., Rocchi L., Khoperia M., Mirisola M.C., Testa R., and Leonardi C.

Summary: Background: The prevalence of HCV-related liver disease among Italian drug addicts is high. Although screening for HCV infection should be offered to all injection drug users (IDUs), only a few of them have been tested for the virus in recent years, and even fewer have been treated. Aims: To assess the prevalence of HCV infection in an IDU sample in Rome and to compare adherence to treatment in Italian vs non-Italian patients. Methods: 261 IDUs underwent screening for HCV, HBV and HIV infection. Patients eligible for treatment were treated with Directly Observed Therapy (DOT). Results: The prevalence of HCV infection among IDUs screened in our Unit was 47.1% (123/261). 96 patients were males, 37 females; average age was 46.2±11.2 years. The most frequent genotype was 1 (45.4%) followed by genotype 3 (36.1%), genotype 4 (11.6%) and genotype 2 (6.9%). Among HCV-positive drug addicts, the prevalence of HBsAg and HIV positivity was 7.2% and 1.5%, respectively. Only 23.1% of subjects had been vaccinated, whereas 48.2% were negative for any HBV marker. The HCV-RNA qualitative test was performed on 53.5% (66/123) of patients; of these, 84.3% (56/66) were HCV-RNA positive. A higher percentage of foreign patients started treatment than Italian ones (69.5% versus 48.3%), but a higher percentage of dropouts was reported among immigrants than among Italian drug users (56.2% versus 23.3%) (p<0.05). Conclusions: The present study confirms the importance of DOT therapy (showing a considerably lower percentage of dropouts) and of the multidisciplinary approach, together with the inclusion of cultural mediators in the management of foreign IDUs in overcoming linguistic and cultural barriers, and in raising awareness of the disease.