Management of Special
Groups:
HCV Infection in Intravenous Drug Users
KEY
POINT
- HCV-infected
intravenous drug users should undergo drug rehabilitation prior
to treatment of HCV infection.
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Intravenous (IV) drug
abuse accounts for 60% of all newly acquired cases of HCV infection and
20% to 50% of cases of chronic infection.148
The 1997 NIH Consensus Development Conference recommended that HCV-infected
drug users be referred for treatment of their addiction before being given
antiviral therapy.21 This
approach was justified on the basis that drug use (1) poses a greater short-term
threat to the patient's health than does HCV infection, (2) increases the
risk of adverse events associated with antiviral treatment, and (3) is likely
to lead to poor adherence to treatment.21 149
Drug abusers are also less likely to respond to therapy because of suppressed
cellular immunity. Finally, IV drug users have a higher incidence of psychiatric
disorders.
Some arguments against
delaying HCV treatment have been presented recently, and limited data
suggest the feasibility and effectiveness of treating patients who are
injection-drug users.21 22
Individualization of the assessment and decision-making process has been
advocated so that potentially life-saving treatment is not denied to active
IV drug users and so that the spread of HCV infection may be limited in
this population.150 More
data are needed about this alternate approach. This panel agrees, however,
that drug rehabilitation is at least as important as control of HCV for
these individuals. Whenever possible, successful drug rehabilitation should
precede antiviral treatment.
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