Injection drug use and the hepatitis C virus: considerations for a targeted treatment approach--the case study of Canada.
Infection with the hepatitis C virus (HCV) is a major public health burden in Canada and globally. The literature shows that injection drug use is currently the primary transmission route for HCV, and that a majority of injection drug users (IDUs) are currently infected with HCV in Canada. This article first reviews the burden of HCV within IDU populations and the transmission risks and the treatment implications specific to IDUs. Traditionally, IDUs have been excluded from HCV treatment unless abstaining from illicit drug use. However, recent research suggests that categorical exclusion is not medically necessary. A series of key questions about the feasibility of offering HCV treatment to IDUs in the specific Canadian context are considered, including concerns related to the motivation of treatment for IDUs, treatment delivery, treatment side effects, HCV reinfection, and the social environment. The article concludes that treatment of HCV-infected illicit drug users is both feasible and may be necessary to reduce transmission and adverse outcomes in this high-risk population.
Fischer
Benedikt
B
Department of Public Health Sciences, University of Toronto, Ontario, Canada. benedikt_fischer@camh.net
Haydon
Emma
E
Rehm
Jürgen
J
Krajden
Mel
M
Reimer
Jens
J
D002170:Canada / Q000453:epidemiology; D015897:Comorbidity; D006526:Hepatitis C / Q000453:epidemiology* / Q000628:therapy; D006801:Humans; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D011477:Sex Work; D015819:Substance Abuse, Intravenous / Q000453:epidemiology*