Should patients with hepatitis C undergo medication-assisted treatment for opiate addiction?

Many patients who are addicted to opiates have been exposed to hepatitis C and are infectious. This is not a contra-indication for treatment of their opiate addiction, nor is opiate addiction a contra-indication for treatment of hepatitis C. Treatment of opiate addiction should be accompanied by screening for hepatitis C and other infectious diseases; treatment for the addiction can serve as an avenue for education about and treatment of hepatitis C and other infectious diseases.

Both buprenorphine and methadone are appropriate medications for this population; patients and their clinicians should choose between them, based on patient preference and appropriate clinical issues. NIDA currently is funding a study in the Clinical Trials Network that is assessing the effects of buprenorphine/naloxone or methadone on liver enzymes in hepatitis C-positive and hepatitis C-negative opiate-dependent patients. More.

Both methadone and buprenorphine interact with medications used to treat HIV. Higher doses may be necessary for some of these patients. Clinicians responsible for treating these patients need to be aware of the potential interactions between buprenorphine or methadone and the drugs used for HIV treatment and to carefully monitor them.

Medication-assisted treatment of patients addicted to opiates who also have HIV is particularly important both because participation in the treatment of addiction may foster adherence to HIV treatment and because treatment of the addiction has been shown to reduce the spread of HIV. Physicians who want to treat HIV+ opiate-dependent patients with buprenorphine are referred to a supplement of Clinical Infectious Diseases 43(4):S169-S257, 2006. More.

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