Am Fam Physician. 2011 Mar 15;83(6):647-648.
to the editor: This article is a concise overview of the many issues in diagnosing and treating hepatitis C virus (HCV) infection. However, I would like to point out a discrepancy between the article and the American Association for the Study of Liver Diseases guidelines,1 which are cited in the article. Active drug use is not an absolute contraindication to treatment. The guidelines state: “Treatment of HCV infection can be considered for persons even if they currently use illicit drugs or who are on a methadone maintenance program, provided they wish to take HCV treatment and are able and willing to maintain close monitoring and practice contraception.”1
Ample data show that many current or recent injection drug users can be successfully treated for HCV infection.2 Because injection drug use is a major risk factor, it is vital that these patients receive appropriate care.
1. Ghany MG, Strader DB, Thomas DL, Seeff LB; American Association for the Study of Liver Diseases. Diagnosis, management, and treatment of hepatitis C: an update. Hepatology. 2009;49(4):1335–1374. http://www.aasld.org/practiceguidelines/Documents/Bookmarked%20Practice%20Guidelines/Diagnosis_of_HEP_C_Update.Aug%20_09pdf.pdf. Accessed July 13, 2010.
2. Grebely J, deVlaming S, Duncan F, Viljoen M, Conway B. Current approaches to HCV infection in current and former injection drug users. J Addict Dis. 2008;27(2):25–35.
in reply: As discussed in our article, intravenous drug use is the leading risk factor for chronic hepatitis C virus (HCV) infection.1 All persons with chronic HCV infection should be considered candidates for treatment.2 Providing safe and effective therapy to those most at risk of chronic HCV infection (e.g., persons with active substance abuse) is essential to their future health. The American Association for the Study of Liver Diseases states that more data are necessary to determine the safety and effectiveness of treatment of chronic HCV infection for certain groups, such as persons with renal disease, depression, or active substance abuse; children; and those with human immunodeficiency virus and HCV coinfection.3
Risks and benefits of treating persons with active alcohol or substance abuse should be assessed, and treatment for chronic HCV infection individualized. Many persons who are actively injecting illicit drugs are not willing to adhere to HCV treatment and precautions regarding contraception, and are less likely to comply with regular follow-up visits.3 Active substance abuse may not be an absolute contraindication, but treatment of HCV infection should be considered for persons continuing to use illicit drugs only if they are able and willing to maintain close monitoring and practice contraception.3 Continued support from drug abuse and psychiatric counseling services is an important adjunct to treatment of HCV infection in persons who use illicit drugs.3
1. Kaur S, Rybicki L, Bacon BR, Gollan JL, Rustgi VK, Carey WD. Performance characteristics and results of a large-scale screening program for viral hepatitis and risk factors associated with exposure to viral hepatitis B and C: results of the National Hepatitis Screening Survey. National Hepatitis Surveillance Group. Hepatology. 1996;24(5):979–986.
2. Strader DB, Wright T, Thomas DL, Seeff LB; American Association for the Study of Liver Diseases. Diagnosis, management, and treatment of hepatitis C. [published correction appears in Hepatology. 2004; 40(1):269]. Hepatology. 2004;39(4):1147–1171.
3. Ghany MG, Strader DB, Thomas DL, Seeff LB; American Association for the Study of Liver Diseases. Diagnosis, management, and treatment of hepatitis C: an update. Hepatology. 2009;49(4):1335–1374. http://www.aasld.org/practiceguidelines/Documents/Bookmarked%20Practice%20Guidelines/Diagnosis_of_HEP_C_Update.Aug%20_09pdf.pdf. Accessed July 13, 2010.
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