Medicine Today Internal Medicine Webcast Series

Hepatitis C Management:

Management of Special Groups:
HCV Infection in Intravenous Drug

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Key Points

  • HCV-infected intravenous drug users should undergo drug rehabilitation prior to treatment of HCV infection.

Intravenous (IV) drug abuse accounts for 60% of all newly acquired cases of HCV infection and 20% to 50% of cases of chronic infection.120 The 1997 NIH Consensus Development Conference recommended that HCV-infected drug users be referred for addiction treatment before being given antiviral therapy. 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. 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.21

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 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. 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.

One group has reported the possible progression of fibrosis with daily use of cannibus,121 while other data have shown a marked increase in sustained viral response, primarily as a result of compliance and improved quality of life amongst the cannibus users.122 Lastly, a Spanish group warns us of the poor future in this patient population.123 They noted that of the 300,000-plus people treated for heroin dependence, 20,000 to 25,000 died from overdose, 100,000 became infected with HIV through drug injection, and many more were infected with the hepatitis virus.

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