Topic Highlight
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World J Gastroenterol. Sep 28, 2014; 20(36): 12722-12733
Published online Sep 28, 2014. doi: 10.3748/wjg.v20.i36.12722
Eligibility of persons who inject drugs for treatment of hepatitis C virus infection
Amber Arain, Geert Robaeys
Amber Arain, Geert Robaeys, Department of Gastroenterology and Hepatology, Ziekenhuis Oost-Limburg, 3600 Genk, Belgium
Amber Arain, Geert Robaeys, Faculty of Medicine and Life Sciences, Hasselt University, 3590 Diepenbeek, Belgium
Geert Robaeys, Department of Hepatology, UZ Leuven, 3000 Leuven, Belgium
Author contributions: Arain A and Robaeys G contributed equally to this work; both authors performed the literature review and wrote the paper.
Supported by Limburg Clinical Research Program (LCRP) and by the Limburg Sterk Merk Foundation of Hasselt University, Ziekenhuis Oost-Limburg and Jessa Hospital
Correspondence to: Geert Robaeys, MD, PhD, Department of Gastroenterology and Hepatology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600 Genk, Belgium. geert.robaeys@zol.be
Telephone: +32-89-326505 Fax: +32-89-327916
Received: November 20, 2013
Revised: April 3, 2014
Accepted: May 19, 2014
Published online: September 28, 2014
Processing time: 315 Days and 18.2 Hours
Abstract

In this decade, an increase is expected in end-stage liver disease and hepatocellular carcinoma, most commonly caused by hepatitis C virus (HCV) infection. Although people who inject drugs (PWID) are the major source for HCV infection, they were excluded from antiviral treatments until recently. Nowadays there is incontrovertible evidence in favor of treating these patients, and substitution therapy and active substance use are no longer contraindications for antiviral treatment. The viral clearance in PWID after HCV antiviral treatment with interferon or pegylated interferon combined with ribavirin is comparable to the viral clearance in non-substance users. Furthermore, multidisciplinary approaches to delivering treatment to PWID are advised, and their treatment should be considered on an individualized basis. To prevent the spread of HCV in the PWID community, recent active PWID are eligible for treatment in combination with needle exchange programs and substitution therapy. As the rate of HCV reinfection is low after HCV antiviral treatment, there is no need to withhold HCV treatment due to concerns about reinfection alone. Despite the advances in treatment efficacies and data supporting their success, HCV assessment of PWID and initiation of antiviral treatment remains low. However, the proportion of PWID assessed and treated for HCV is increasing, which can be further enhanced by understanding the barriers to and facilitators of HCV care. Removing stigmatization and implementing peer support and group treatment strategies, in conjunction with greater involvement by nurse educators/practitioners, will promote greater treatment seeking and adherence by PWID. Moreover, screening can be facilitated by noninvasive methods for detecting HCV antibodies and assessing liver fibrosis stages. Recently, HCV clearance has become a major endpoint in the war against drugs for the Global Commission on Drug Policy. This review highlights the most recent evidence concerning HCV infection and treatment strategies in PWID.

Keywords: Hepatitis C virus; Persons who inject drugs; Methadone; Sustained viral response; Adherence

Core tip: People who inject drugs are considered to be the main reservoir for hepatitis C virus (HCV) infection. Accumulating evidence indicates that HCV-infected injection drug users can be successfully treated, and the earlier they are treated, the better the outcome. Therefore, in the future, the barriers for antiviral treatment for these individuals must be overcome. This topic highlight presents the most recent data concerning HCV infection and treatment of injection drug users.