Editorial
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 28, 2017; 23(20): 3569-3571
Published online May 28, 2017. doi: 10.3748/wjg.v23.i20.3569
Hepatitis C in injection drug users: It is time to treat
Alberto Grassi, Giorgio Ballardini
Alberto Grassi, Giorgio Ballardini, Internal Medicine and Hepatology Division, Infermi Hospital, 47921 Rimini, Italy
Author contributions: Grassi A contributed to conception and design of the study, acquisition of data, analysis and interpretation of data; Ballardini G made critical revisions related to important intellectual content of the manuscript and final approval of the paper.
Conflict-of-interest statement: Grassi A and Ballardini G declare no conflict of interest related to this publication.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Alberto Grassi, MD, PhD, Internal Medicine and Hepatology Division, Infermi Hospital, Viale Settembrini 2, 47921 Rimini, Italy. albgrassi@yahoo.com
Telephone: +39-541-705623 Fax: +39-541-705342
Received: January 28, 2017
Peer-review started: February 9, 2017
First decision: March 3, 2017
Revised: March 15, 2017
Accepted: March 30, 2017
Article in press: March 30, 2017
Published online: May 28, 2017
Abstract

Injection drug users (IDUs) are at risk of hepatitis C virus (HCV) infection, due to needle and syringe sharing. Chronic HCV infection is a major cause of liver-related morbidity and mortality but can be cured with antiviral treatment leading to sustained viral response (SVR). It is well demonstrated that, when close cooperation between specialists in drug addiction and psychiatrists is assured, patients on maintenance treatment with methadone/buprenorphine can be treated for HCV with response rate, tolerability and side effects similar to those reported in non-IDUs. Current guidelines recommend that active injection drug use should not exclude patients from HCV treatment, but many services remain reluctant to treat IDUs. No significant pharmacodynamic interactions were reported between approved direct anti-viral agents (DAAs) and buprenorphine or methadone. Dose adjustments are not recommended; therefore DAAs appear to be the “perfect” therapy for patients taking opiate substitutive therapy. These suggestions have been recently recognized by the European Association for the Study of the Liver (EASL) and included in EASL Recommendations on Treatment of Hepatitis C 2016. Guidelines confirm that HCV treatment for IDUs should be considered on an individualized basis and delivered within a multidisciplinary team setting; a history of intravenous drug use and recent drug use at treatment initiation are not associated with reduced SVR and decisions to treat must be made on a case-by-case basis.

Keywords: Hepatitis C, Drug users, Peg-interferon, Direct antiviral agents, Hepatitis C virus treatment

Core tip: It is well demonstrated that injection drug users (IDUs) on maintenance treatment with methadone/buprenorphine can be treated for hepatitis C virus (HCV) with response rate, tolerability and side effects similar to those reported in non-IDUs. European Association for the Study of the Liver Recommendations on Treatment of Hepatitis C 2016 confirm that HCV treatment for IDUs should be considered on an individualized basis and delivered within a multidisciplinary team setting; a history of intravenous drug use and recent drug use at treatment initiation are not associated with reduced sustained viral response and decisions to treat must be made on a case-by-case basis.