Managing Hepatitis C in Users of Illicit Drugs

Abstract

Persons who inject illicit drugs are the group most severely affected by the hepatitis C epidemic but the least likely to receive treatment. Controlling the epidemic will require developing strategies for effectively treating drug users. A growing number of reports have shown that a substantial proportion of drug users treated for hepatitis C can achieve sustained virologic responses even if they have psychiatric comorbidity and even if they continue to use drugs while receiving hepatitis C treatment. Successfully treating hepatitis C in injection drug users requires collaboration between those with expertise in hepatitis and those with expertise in caring for substance users. Careful attention to management of adverse effects and strong links with mental health services are important. Further research is needed to better define which patients can be successfully treated and the program elements that are critical for success. In the meantime, substantial progress can be made using current knowledge if appropriate resources are brought to bear.

Figure 1. Response Rates among Injection Drug Users Treated for Hepatitis C

In studies that included patients who continued using illicit drugs while receiving antiviral therapy, SVR rates were generally modestly reduced, but differences were not statistically significant in any study, and substantial proportions of nonabstinent patients still responded favorably to treatment. SVR=sustained virologic response. MMT=methadone maintenance treatment.