Treatment of hepatitis C virus infection in drug addicts
Annals of Hepatology
Injected drug users constitute the biggest category of hepatitis C virus (HCV) cases in the United States. This group also has the greatest number of new infections per year. It is estimated that about 80%-95% of all users of needles are infected with HCV. Eighty percent of intravenous drug users are infected with HCV during their first year of using needles. The prevalence of hepatitis C is 100% among those that have used intravenous drugs for more than 8 years. This means that 1.5-2 million
... hat 1.5-2 million of the 15 million users of illegal drugs in the United States are infected with HCV. 1 The discussion about whether HCV treatment should be offered to users of illegal drugs is confounded by a number of myths and falsehoods. For instance, it has been said that only drug addicts who use needles are at risk of acquiring HCV. This is false. It is estimated that the prevalence of HCV infection in people who administer cocaine nasally is 33%. Recent studies have shown that about 77% of cocaine users have chronic hepatitis C. Likewise, the use of amphetamines such as methamphetamine (speed or crystal-met) has been associated with increased transmission of HCV and acquired immunodeficiency virus (HIV) in homosexuals. 2 What is true is that some transmission routes of HCV in illegal substances users are not clear. Drug users are stigmatized and have a high prevalence of health problems. Arguments for denying this population treatment for chronic hepatitis C may be based on prejudice and discrimination, from which health professionals are not exempt. We should only reject treatment on the basis of research data. To deny treatment to a population may condemn them to severe liver disease. 4, 5 What arguments have been proposed to deny treatment to active drug users? Drug users have a high prevalence of psychiatric disease and a high risk of severe complications during HCV treatment. Drug addicts do have a high prevalence of psychiatric diseases such as depression, bipolar disorder, and anxiety. However, it is also true that patients with chronic hepatitis C who are not active addicts have a high prevalence of psychiatric disease, especially depression (24%-30%).    No study has proved that the number or severity of psychiatric events of active users of methadone differs from that of patients with chronic hepatitis C who are not active users of methadone. Drug users have poor adherence to HCV treatment. This is a myth. Many studies of addicts and users of methadone have shown that adherence of this group to HCV treatment is no different from that of people who are not addicted to drugs. Moreover, recent studies have failed to detect significant differences between users and nonusers of needles in respect of the results of viral load tests and liver biopsies, and in sustained viral responses. 9,10 Drug users are reinfected with HCV.