Hepatitis C in injection drug users: It is time to treat

Abstract

Injection drug users (IDUs) are at risk of hepatitis C virus (HCV) infection, due to needle and syringe sharing. Chronic HCV infection is a major cause of liver-related morbidity and mortality but can be cured with antiviral treatment leading to sustained viral response (SVR). It is well demonstrated that, when close cooperation between specialists in drug addiction and psychiatrists is assured, patients on maintenance treatment with methadone/buprenorphine can be treated for HCV with response rate, tolerability and side effects similar to those reported in non-IDUs. Current guidelines recommend that active injection drug use should not exclude patients from HCV treatment, but many services remain reluctant to treat IDUs. No significant pharmacodynamic interactions were reported between approved direct anti-viral agents (DAAs) and buprenorphine or methadone. Dose adjustments are not recommended; therefore DAAs appear to be the “perfect” therapy for patients taking opiate substitutive therapy. These suggestions have been recently recognized by the European Association for the Study of the Liver (EASL) and included in EASL Recommendations on Treatment of Hepatitis C 2016. Guidelines confirm that HCV treatment for IDUs should be considered on an individualized basis and delivered within a multidisciplinary team setting; a history of intravenous drug use and recent drug use at treatment initiation are not associated with reduced SVR and decisions to treat must be made on a case-by-case basis.

A systematic review and meta-analysis of the prevalence of hepatitis C virus infection in people who inject drugs in Iran

“…2 The forest plot of the studies included in the present systematic review and meta-analysis differences in health systems, screening methods, and the type of high-risk behaviors of individuals [77,78]. In particular, in developing countries, harm reduction programs such as syringe distribution are not fully implemented [79]. Furthermore, because of the high cost of diagnostic services, many PWID are not aware of their health status.…”

Harm reduction program and hepatitis C prevalence in people who inject drugs (PWID) in Iran: an updated systematic review and cumulative meta-analysis

“…These differences in the prevalence can be attributed to differences in the health systems, screening methods, and the type of high-risk behaviors of individuals [ 109 , 110 ]. In particular, in the developing countries, the harm reduction programs such as syringe distribution are not fully implemented [ 111 ]. Moreover, in the countries with high coverage of HCV care, cases are diagnosed and treated earlier and the transmission of HCV is prevented in the community, which can also be the reason for the inconsistent findings among different studies [ 112 , 113 ].…”

HCV seroconversion in a cohort of people who use drugs followed in a mobile harm reduction unit in Madrid: Breaking barriers for HCV elimination

“…Efforts should be directed to break barriers in the cascade of HCV treatment in the next years [ 22 ]) and forward individualized therapy for all people who actively inject drugs within an addiction care setting. Recently, EASL recommendations confirm that HCV treatment for PWID should be considered on an individualized basis and delivered within a multidisciplinary team setting, regardless a history of intravenous drug use and recent drug use [ 30 ]). Indeed, we think that new models of care for this population, such as the MHRUs, are the places suitable for HCV treatment and follow-up, that include linkage to specialized consultation, surveillance of adherence to HCV treatment, adverse effects monitoring and prevention of reinfection.…”