***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: AIM To evaluate the effect of a multi-disciplinary st and ardized management model on the efficacy of pegylated (Peg)-interferon alpha-2b plus ribavirin treatment of chronic hepatitis C in drug addicts undergoing substitutive or antagonist therapy . DESIGN Observational prospect i ve multi-centre study . SETTING Six clinical infectious disease centres in collaboration with 11 drug dependency units ( DDU ) in five Italian regions . PARTICIPANTS Intravenous drug users affected by chronic hepatitis C engaged in detoxification programmes . METHODS Application of a multi-disciplinary st and ardized management model for HCV treatment involving DDU operators , psychologists or psychiatrists and infectious disease specialists . MEASUREMENTS Very early , early , end-of-treatment and sustained virological response to Peg-interferon alpha-2b plus ribavirin . FINDINGS Fifty-three subjects were studied [ 43.4 % with hepatitis C virus ( HCV ) genotypes 1 or 4 ] . Intent-to-treat analysis showed an end-of-treatment virological response in 58.5 % of patients ( 39.1 % genotypes 1 or 4 ; 73.4 % genotype 3 ) and a sustained virological response in 54.7 % ( 34.8 % genotypes 1 or 4 ; 70.0 % genotype 3 ) . There were 19 ( 35.8 % ) dropouts and three ( 5.7 % ) non-responders : one genotype 1 and two genotype 4 . Two ( 3.8 % ) patients relapsed : genotypes 1 and 3 . On-treatment analysis showed negative HCV-RNA in 40 ( 93.1 % ) of 43 subjects who completed the first 12 treatment weeks and in 35 who completed the first 24 treatment weeks . All subjects with an end-of-treatment response , except one with genotype 3 infection , had a sustained response . CONCLUSIONS Our data show that antiviral treatment in the context of a multi-disciplinary st and ardized management model helps many HCV-positive drug addicts achieve a good virological response Chronic hepatitis C is the most common infectious disease among injection drug users ( IDUs ) . Because of the allegedly poor compliance of IDUs with treatment requirements and conditions , hepatologists recommend treatment only if former IDUs have spent 6 to 12 months drug free . The aim of this prospect i ve study was to investigate whether opiate‐dependent IDUs with chronic hepatitis C virus ( HCV ) infection can be treated successfully with interferon . Eligibility for the study meant IDUs had to be HCV‐RNA positive by polymerase chain reaction . Subsequently 50 in patients were enrolled during detoxification treatment . HCV treatment was started with interferon alfa‐2a ( through 1998 ) or a combined regimen consisting of interferon alfa‐2a and ribavirin ( begun in 1998 ) . All patients were treated and supervised by specialized physicians in both hepatology and addiction medicine . The end point for this study was defined as a loss of detectable serum HCV RNA at week 24 after treatment . The rate of sustained virologic response was 36 % . Sustained response rates were not significantly different for patients who relapsed and returned to treatment ( 53 % ) , relapsed and did not return to treatment ( 24 % ) , or did not relapse ( 40 % ; P > .05 ) . During the 24 weeks after treatment , we were unable to detect any reinfection , even among patients who injected heroin during this period . This surprising result should be examined in further studies . In conclusion , HCV‐infected drug addicts with chronic HCV infection can be treated successfully with interferon alfa‐2a and ribavirin if they are closely supervised by physicians specialized in both hepatology and addiction medicine BACKGROUND / AIMS Treatment with interferon-alpha ( IFN-alpha ) may eradicate HCV in most acute hepatitis C patients , thus preventing chronic hepatitis and avoiding less efficacious combination therapy . METHODS In a prospect i ve study , we evaluated the impact of barriers to successful start and completion of treatment of acute and subacute ( < 12 months from infection ) hepatitis C with pegylated IFN-alpha2b , 1.5 microg/kg , QW , for 24 weeks . RESULTS Out of 27 patients ( 22 were active intravenous drug users [ IVDU ] ) , 5 cleared HCV spontaneously . Antiviral treatment was indicated in 22 patients : six refused therapy for fear of side effects , whereas two others were lost to observation . Eight patients completed the treatment or received > 80 % of the scheduled drug : seven ( 88 % ) were sustained virological responders 24 weeks after the end of treatment . Six patients ( all IVDU ) stopped prematurely due to side effects : only one had a sustained virological response . Based on an intent-to-treat analysis , and considering all 14 patients in whom at least one dose of drug was administered , only 8 ( 57 % ) became sustained virological responders . CONCLUSIONS Treatment of acute hepatitis C with pegylated IFN-alpha is highly beneficial , but its effectiveness is affected by a poor rate of acceptance and /or adherence to currently available regimens , especially in IVDU and women Background : Though patients in opiate substitution programs are commonly infected with HCV , due to safety and efficacy concerns , they are rarely treated with interferon and ribavirin . Methods : In a multicenter study , HCV-infected patients in opiate maintenance treatment programs received 180 μg pegylated interferon-alfa-2a once weekly , plus daily ribavirin for 24 weeks ( genotypes 2 , 3 ) , or 48 weeks ( genotypes 1 , 4 ) . Results : Of the 67 patients enrolled , 31 ( 46 % ) had HCV genotypes 1 or 4 , and 36 ( 54 % ) had genotypes 2 or 3 . Intent-to-treat analysis showed end-of-treatment virologic response in 75 % of patients ( 81 % of genotypes 2 or 3 ; 65 % of genotypes 1 or 4 ) , and a sustained virologic response in 61 % of patients ( 72 % of genotypes 2 or 3 ; 48 % of genotypes 1 or 4 ) . Fifteen patients ( 22 % ) did not complete the study , in 5 ( 8 % ) cases because of severe adverse events . Conclusions : Drug users with chronic HCV infection , regularly attending an opiate maintenance program in which close collaboration between hepatologists/internists and addiction specialists is assured , can be treated effectively and safely  with pegylated interferon-alfa-2a and ribavirin . Treatment results are very similar to those in other patient groups , and thus therapy should also be considered for this population OBJECTIVE Recent guidelines on the management of patients chronic hepatitis C virus ( HCV ) infection recommend the same anti-HCV therapy for active intravenous drug users and other patients , however some physicians are reluctant to treat active drug users . The aim of this study was to compare hepatitis C management practice s and clinical outcome after treatment between active intravenous drug users and other patients . METHODS Four hundred and thirty-five naive HCV seropositive patients were recruited from 1990 to 2000 and followed up for a mean period of 2.5 years ( SD 1 Year ) . At the beginning of the study , 116 of the patients were active intravenous drug users . Social , clinical , biological and histological data were collected . The different steps of HCV management and responses to treatment were compared between active intravenous drug users and other patients . RESULTS There was no statistically significant difference in HCV management practice s and compliance between active intravenous drug users and other patients : search for viral RNA ( 85 % versus 67 % ) , liver biopsy performed when indicated ( 82 % versus 87 % ) , initiation of anti-HCV treatment ( 33.6 % versus 43.2 % ) , loss to follow up during treatment ( 24 % vs 16 % ) . The rate of sustained viral response was not significantly different between active intravenous drug users and other patients ( 28 % versus 21 % ) . At multivariate analysis , factors independently associated with sustained viral response were female gender ( OR=5.6 [ 1.02 - 41.2 ] ) , genotype 3 ( OR=29.7 [ 1.4 - 61.7 ] ) , low viral load ( OR=33.3 [ 2.25 - 100 ] ) , low fibrosis score ( OR=1.4 [ 1.0 - 2.0 ] ) , elevated transaminase level ( OR=12.7 [ 0.9 - 97.2 ] ) , and bitherapy protocol ( OR=10 [ 1.18 - 85.3 ] ) . CONCLUSION This study illustrates that active intravenous drug use does not affect either patient compliance with proposed management or viral response to treatment , but pluridisciplinary care should focus both on drug addiction and HCV infection Background Injecting drug use is the main risk factor for hepatitis C virus ( HCV ) infection . Secondary ‐care‐based strategies for the management of HCV do not effectively target this vulnerable population Objective Injection drug users are often excluded from hepatitis C virus ( HCV ) treatment . This study compares sustained virological response , adherence , and quality of life in patients with or without a history of illicit drug use in routine clinical practice . Methods This is a post-hoc analysis of a prospect i ve , observational study conducted in 1860 patients who received peginterferon α-2b/ribavirin combination therapy . Nondrug users ( NDUs ) were defined as patients without a history of drug addiction ; former drug users ( FDUs ) as patients who had stopped using illicit drugs or opioid maintenance therapy and active drug users ( ADUs ) as patients using illicit drugs or on opioid maintenance therapy .  Virological response , adherence , and the health-related quality of life were assessed by the measure of HCV RNA in the serum , self-report and 36-item short-form health survey Question naire , respectively . Results The analyzed population included 1038 ( 56 % ) NDUs , 578 ( 31 % ) FDUs , and 244 ( 13 % ) ADUs . About 85 % of ADUs were on opioid maintenance therapy and 25 % used illicit drugs . Although ADUs had a more chaotic lifestyle and more psychiatric disorders , sustained virological response of ADUs ( 58 % ) did not differ from that of NDUs ( 49 % ) and FDUs ( 51 % ) ( P=0.133 ) . Adherence rates were 39 % in NDUs and FDUs , and 37 % in ADUs ( P=0.883 ) . Health-related quality of life was improved in the three groups after the end of treatment . Conclusion Our study suggests that HCV therapy in ADUs on opioid maintenance therapy is as effective as in other HCV patients . The effectiveness of HCV therapy in illicit drug users needs to be evaluated in further studies BACKGROUND & AIMS Patients with acute hepatitis C virus ( HCV ) infection who receive treatment achieve high rates of sustained virologic response ( SVR ) , but few studies have examined outcomes among injecting drug users ( IDUs ) . We evaluated the efficacy of treatment of recent HCV infection in IDUs with acute and early chronic HCV . METHODS We analyzed data from the Australian Trial in Acute Hepatitis C-a prospect i ve study of the natural history and treatment outcomes of patients with recent HCV infection . Participants eligible for the study had their first anti-HCV antibody-positive test result within the past 6 months and either acute clinical HCV within the past 12 months or documented anti-HCV seroconversion within 24 months . Participants with HCV received pegylated interferon-alfa-2a  ( 180 microg/wk , n = 74 ) ; those with HCV/human immunodeficiency virus ( HIV ) co-infection  received pegylated interferon-alfa-2a ( 180 microg/wk ) with ribavirin ( n = 35 ) for 24 weeks . RESULTS From June 2004 to February 2008 , 167 participants were enrolled in the Australian Trial in Acute Hepatitis C ; 79 % had injected drugs in the previous 6 months . Among 74 with only HCV , the SVRs were 55 % and 72 % by intention-to-treat and per- protocol analysis , respectively . In multivariate analyses , baseline factors independently associated with lower SVR included decreased social functioning and current opiate pharmacotherapy . Adherent participants had higher SVR rates ( 63 % vs 29 % ; P = .025 ) . Of the 35 participants with HCV/HIV co-infection , the SVRs were 74 % and 75 % by intention-to-treat and per- protocol analysis , respectively . CONCLUSIONS Treatment of recent HCV infection among IDUs , including those with HIV co-infection , is effective . Strategies to engage socially marginalized individuals and increase adherence should improve treatment outcomes in this population 
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Conclusions This systematic review indicates that hepatitis C treatment uptake is relatively low among drug users in several European countries , and also points to considerable knowledge gaps regarding treatment uptake levels in this population .
There was large variability in treatment uptake levels , suggesting that there may be major differences between and within countries in relation to treatment availability , drug-using population s in need of treatment , and the existence of integrated health care services targeting drug users .