Case Series on the Safe Use of Buprenorphine/Naloxone in Individuals with Acute Hepatitis C Infection and Abnormal Hepatic Liver Transaminases

Abstract

Background: Hepatitis C virus (HCV) is the most prevalent chronic viral illness in the United States. Many individuals with virus HCV are opioid dependent requiring treatment with opiate substitution treatment such as buprenorphine. Previous reports in the literature have suggested hepatotoxicity with buprenorphine tempering initial enthusiasm of the safety of buprenorphine in HCV-infected patients. Methods: As part of an ongoing SAMHSA-funded grant to expand opiate substitution therapy with buprenorphine, all opioid-dependent patients seeking treatment with buprenorphine undergo a laboratory evaluation including transaminases (AST/ALT) as well as laboratory evaluation for acute and chronic hepatitis. Results: Of the 121 patients screened for entry into buprenorphine treatment, 4 patients had evidence of acute HCV infection. Conclusions: Despite markedly elevated transaminases in the setting of acute hepatitis C infection, these patients tolerated buprenorphine treatment with improvement in their transaminases during the course of buprenorphine treatment.

Keywords:

• Acute hepatitis C
• abnormal transaminases
• buprenorphine
• clinical care
• opioid agonist therapy