Directly Observed Pegylated Interferon Plus Self-Administered Ribavirin for the Treatment of Hepatitis C Virus Infection in People Actively Using Drugs: A Randomized Controlled Trial

Background. This study investigated the efficacy and safety of directly observed pegylated interferon (peg-IFN) alfa-2a plus self-administered ribavirin (RBV) for the treatment of hepatitis C virus (HCV) among people with active drug use. Methods. A randomized, open-label, parallel group trial of immediate vs delayed treatment with peg-IFN alfa-2a plus RBV in participants with recent injection drug and/or crack cocaine use (prior 3 months). The primary end point was sustained virologic response (SVR). Results. Sixty-six participants were randomized (immediate treatment, n = 48; delayed treatment, n = 18). Loss to follow-up was comparable among those randomized to immediate and delayed treatment (23% vs 33%, P= .389). In a post hoc intent-to-treat analysis of all randomized individuals, the SVR was 65% (95% confidence interval [CI], 49%–78%; 31/48) in those randomized to immediate treatment as compared to 39% (95% CI, 17%–64%; 7/18) in those randomized to delayed treatment (P= .060). Among those who received delayed treatment (12/18), SVR was 58% (7/12). Among 60 participants who received at least 1 dose of study medication, SVR was 63% (95% CI, 50%– 75%, n = 38). Recent drug use at baseline (past month) did not impact completion or SVR. Discontinuation due to adverse events occurred in 7%. The HCV reinfection rate was 2.8 per 100 person-years (95% CI, 0.0–14.5 personyears) with 1 reinfection observed among 23 remaining in follow-up post-SVR (median, 1.8 years; range, 0.5–1.8 years). Conclusions. Among people actively using drugs treated with directly observed peg-IFN alfa-2a plus selfadministered RBV, SVR is comparable to that seen in clinical trials of non–drug users, and the rate of HCV reinfection is low. Clinical Trials Registration. NCT00203606.