title: Hepatitis C and substance use:  new treatments and novel approaches.
abstract: OBJECTIVE
  To provide an update on new treatment approaches for patients with hepatitis C virus (HCV) infection and substance use. This issue is of extreme importance for HCV, as many patients have substance-use histories.
  
  
  RESULTS
  Recent emergence of two new protease inhibitors, boceprevir and telaprevir, to enhance the modern treatment of HCV have boosted the sustained virologic response rate to about 80%, a 30% increase over prior standard of care with interferon and ribavirin. Unfortunately, many providers are reluctant to treat patients with substance-use histories unless they have demonstrated abstinence for at least 6 months, and there is a spoken and unspoken bias against these patients. Emerging new studies have shown that even current injection drug users can be treated successfully with results comparable to patients who are abstinent and those with no drug-use histories, especially with attention to the patient's substance use and other psychiatric problems.
  
  
  CONCLUSIONS
  Newer treatment approaches for HCV will help many more patients than ever before to overcome the virus. Changed attitudes and innovative approaches to patients with substance-use histories are needed to bring these scientific advances to this segment of the population of patients with HCV.
authors.affiliation: The VA North Texas Healthcare System and the Departments of Psychiatry and Surgery/Division of Emergency Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas 75390-8828, USA. Carol.North@utsouthwestern.edu
authors.forename: Carol S
authors.initials: CS
authors.lastname: North
authors.forename: Barry A
authors.initials: BA
authors.lastname: Hong
authors.forename: Thomas
authors.initials: T
authors.lastname: Kerr
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D004359:Drug Therapy, Combination; D006297:Health Services Accessibility; D006526:Hepatitis C / Q000188:drug therapy*; D006801:Humans; D009842:Oligopeptides / Q000627:therapeutic use; D011392:Proline / Q000031:analogs & derivatives / Q000627:therapeutic use; D011480:Protease Inhibitors / Q000627:therapeutic use*; D019966:Substance-Related Disorders / Q000188:drug therapy*
chemical_list: D000998:Antiviral Agents; D009842:Oligopeptides; D011480:Protease Inhibitors; C486464:telaprevir; C512204:N-(3-amino-1-(cyclobutylmethyl)-2,3-dioxopropyl)-3-(2-((((1,1-dimethylethyl)amino)carbonyl)amino)-3,3-dimethyl-1-oxobutyl)-6,6-dimethyl-3-azabicyclo(3.1.0)hexan-2-carboxamide; D011392:Proline