Recommendations for the management of hepatitis C virus infection among people who inject drugs.
In high income countries, the majority of new and existing hepatitis C virus (HCV) infections occur among people who inject drugs (PWID). In many low and middle income countries large HCV epidemics have also emerged among PWID populations. The burden of HCV-related liver disease among PWID is increasing, but treatment uptake remains extremely low. There are a number of barriers to care which should be considered and systematically addressed, but should not exclude PWID from HCV treatment. The rapid development of interferon-free direct-acting antiviral (DAA) therapy for HCV infection has brought considerable optimism to the HCV sector, with the realistic hope that therapeutic intervention will soon provide near optimal efficacy with well-tolerated, short duration, all oral regimens. Further, it has been clearly demonstrated that HCV treatment is safe and effective across a broad range of multidisciplinary healthcare settings. Given the burden of HCV-related disease among PWID, strategies to enhance HCV assessment and treatment in this group are urgently needed. These recommendations demonstrate that treatment among PWID is feasible and provide a framework for HCV assessment and care. Further research is needed to evaluate strategies to enhance testing, linkage to care, treatment, adherence, viral cure, and prevent HCV reinfection among PWID, particularly as new interferon-free DAA treatments for HCV infection become available.
Kirby Institute, UNSW Australia, Sydney, Australia. Electronic address: jgrebely@kirby.unsw.edu.au.
Jason
J
Grebely
Department of Gastroenterology and Hepatology, Ziekenhuis Oost Limburg, Genk, Belgium; Department of Hepatology, UZ Leuven, Leuven, Belgium; Faculty of Medicine and Life Sciences, Limburg Clinical Research Program, Hasselt University, Hasselt, Belgium.
Geert
G
Robaeys
Arud Centres of Addiction Medicine, Zurich, Switzerland.
Philip
P
Bruggmann
A.M. Migliavacca Center for Liver Disease, Division of Gastroenterology and Hepatology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy.
Alessio
A
Aghemo
Ludwig-Maximilians-University, Munich, Germany; Praxiszentrum im Tal Munich, Munich, Germany.
Markus
M
Backmund
CRCHUM, Université de Montréal, Montreal, Canada.
Julie
J
Bruneau
International Network of People who Use Drugs, Canberra, Australia.
Jude
J
Byrne
Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway.
Olav
O
Dalgard
University of Toronto, Toronto, Canada.
Jordan J
JJ
Feld
Burnet Institute, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
Margaret
M
Hellard
School of Social & Community Medicine, University of Bristol, Bristol, United Kingdom.
Matthew
M
Hickman
European Liver Patients Association, Cologne, Germany.
Achim
A
Kautz
Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, United States.
Alain
A
Litwin
Inflammation and Infection Research Centre, School of Medical Sciences, UNSW Australia, Sydney, Australia.
Andrew R
AR
Lloyd
Center for HIV and Hepatogastroenterology, Düsseldorf, Germany.
Stefan
S
Mauss
Department of Research, Cluster Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands; Department of Internal Medicine, CINIMA, Academic Medical Centre, Amsterdam, The Netherlands.
Maria
M
Prins
Treatment Action Group, New York, United States.
Tracy
T
Swan
Department of Psychiatry, Psychotherapy and Addiction Medicine, Kliniken Essen-Mitte, Essen, Germany; Department of Psychiatry and Psychotherapy-CCM, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Martin
M
Schaefer
Department of Medicine, Brown University, Providence, RI, United States.
Lynn E
LE
Taylor
Kirby Institute, UNSW Australia, Sydney, Australia.
Gregory J
GJ
Dore
D000998:Antiviral Agents / Q000627:therapeutic use*; D006526:Hepatitis C / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D015819:Substance Abuse, Intravenous / Q000150:complications*
D000998:Antiviral Agents
Drug users; Guidelines; HCV; HIV; Injecting; Injection; PWID