Guidelines for the
management of hepatitis C virus (HCV) infection among people who inject drugs
have been published in a supplement to Clinical
Infectious Diseases. Developed by an expert panel on behalf of the
International Network of Hepatitis in Substance Abuse, the recommendations
cover topics including the natural history of HCV, non-invasive methods of
assessment, indications for HCV therapy, treatment strategies, adherence and
mental health, the management of HIV and/or hepatitis B virus (HBV)
co-infection and liver transplant.
believe the guidelines “demonstrate that treatment among PWID [people who
inject drugs] is feasible,” and also provide “a framework for HCV
assessment, management, and treatment.”
In the developed
world, between 50 and 80% of individuals who inject drugs – both current and past
injectors – are have HCV. Liver disease is an increasingly importance
cause of serious illness and death in this population.
guidelines excluded people who inject drugs from HCV therapy. This was due to
concerns about adherence, side-effects and re-infection. However, successful
outcomes have been observed among current and former drug users. Guidelines
therefore now recommend that therapy for this population should be considered
on a case-by-case basis.
active or former injecting drug users have so far received treatment. An
international team of experts therefore developed the present recommendations
to enhance the assessment, management and treatment of people who inject
recommendations were graded, with the strength reflecting the quality of the
supporting evidence. The quality of the research evidence was classified as A
(high); B (moderate); or C (low). The grade of recommendation was either 1
(strong) or 2 (weak).