title: Prevention, treatment and care of hepatitis C virus infection among people who inject drugs.
abstract: People who inject drugs (PWID) represent the core of the hepatitis C virus (HCV) epidemic in many countries. HCV transmission continues among PWID, despite evidence demonstrating that high coverage of combined harm reduction strategies, such as needle syringe programs (NSP) and opioid substitution treatment (OST), can be effective in reducing the risk of HCV transmission. Among infected individuals, HCV-related morbidity and mortality continues to grow and is accompanied by major public health, social and economic burdens. Despite the high prevalence of HCV infection, the proportion of PWID who have been tested, assessed and treated for HCV infection remains unacceptably low, related to systems-, provider- and patient-related barriers to care. This is despite compelling data demonstrating that with the appropriate programs, HCV treatment is safe and successful among PWID. The approaching era of interferon-free directly acting antiviral therapy has the potential to provide one of the great advances in clinical medicine. Simple, tolerable and highly effective therapy will likely address many of these barriers, thereby enhancing the numbers of PWID cured of HCV infection. However, the high cost of new HCV therapies will be a barrier to implementation in many settings. This paper highlights that restrictive national drug policy and law enforcement are key drivers of the HCV epidemic among PWID. This paper also calls for enhanced HCV treatment settings built on a foundation of both prevention (e.g. NSP and OST) and improved access to health care for PWID.
authors.affiliation: Arud Centres for Addiction Medicine, Zurich, Switzerland. Electronic address: p.bruggmann@arud.ch.
authors.forename: Philip
authors.initials: P
authors.lastname: Bruggmann
authors.affiliation: The Kirby Institute, The University of New South Wales Australia, Sydney, Australia.
authors.forename: Jason
authors.initials: J
authors.lastname: Grebely
mesh_terms: D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use; D017281:Cost of Illness; D016527:Drug Costs; D040261:Harm Reduction; D006291:Health Policy; D006297:Health Services Accessibility; D006526:Hepatitis C / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D018671:Needle-Exchange Programs / Q000458:organization & administration; D058850:Opiate Substitution Treatment / Q000379:methods; D015995:Prevalence; D015819:Substance Abuse, Intravenous / Q000150:complications*
chemical_list: D000998:Antiviral Agents
keywords: Hepatitis C; PWID