Routine practice HCV infection screening with saliva samples: multicentric study in an intravenous drug user population.

OBJECTIVE: The purpose of this randomized multicentric study was to evaluate the diagnostic contribution of screening for HCV infection on saliva samples in day-to-day practice in the intravenous drug-user (IVDU) population. METHODS: Between January and May 2004, 274 presumably HCV-negative IVDU were screened for HCV infection in 15 centers in France (median age 29 years). After centralized randomization, screening tests were performed on blood samples (arm A) or saliva samples (arm B). Screening tests were performed in 78 subjects (28%) had never been screened before and in 196 subjects (72%) who had had a negative HCV screening test on average 12 months prior to the beginning of the study. In the event of a positive saliva test for anti-HCV Ab, a serum test for anti-HCV Ab was performed. In the event of a positive serum test for anti-HCV Ab, PCR was performed on serum to measure HCV-RNA. RESULTS: Fourteen individuals were positive for HCV RNA (7 in each arm). Six of these cases had not been detected before. In eight cases, the median time between the last negative screening test and study inclusion was 11 months (range 6-94 months). CONCLUSIONS: Viremia tests were positive in 5% percent of the target population, although one-third of the individuals in arm A (blood samples) were not tested. The saliva test may be a useful alternative in the event of refusal of a blood test or when poor venous conditions compromise venous puncture. A confirmatory blood test still remains difficult to obtain in nearly half of patients.

[Initiation of methadone replacement therapy in the hospital, prescribing guidelines]. / Initialisation hospitalière d'un traitement substitutif par methadone, recommandations de prescription.

BACKGROUND: The fight against drugs and the prevention of addiction is one of the principle aims of the information sheet DGS/DHOS n(o)2002-57 dated January 30, 2002. This text authorises any practitioner working in a health centre to initiate treatment with methadone. OBJECTIVES: This strategy was set-up in order to make methadone more accessible to drug addicts. It is within this context that the drug and sterile medical device commission of the Philippe Pinel hospital centre of Amiens (80) developed guidelines for the prescription and initiation of replacement therapy with methadone. GUIDELINES: They specify the conditions prior to the prescription as well as the regimen that must be applied during the initiation phase. The modalities of prescription, follow-up and precautions to be taken also figure in the document. Moreover, within the framework of an efficient town-hospital cooperation, the relay conditions to be applied on the release of the patient are detailed. CONCLUSION: Other than simple prescribing recommendations, these guidelines are aimed at improving the global management of drug addicts within the heart of an effective sanitary network.